Incidence and risk factors

The main reason why urethrectomy at the time of radical cystectomy has been advocated is the risk of subsequent urethral recurrence, which is estimated to range from 4-19%.3 The wide variation in the reported incidence of urethral recurrence is due to several factors. The first is the retrospective reviews of patients who were selected for surgical treatment according to different criteria. Secondly, the incidences of carcinoma in situ and of bladder neck or prostatic urethral involvement have not been comparable in the reported studies. Duration of follow-up has also varied widely. Some investigators have considered only clinically overt urethral recurrence, while others have also included patients with carcinoma in situ, or even those with urothelial dysplasia.3 However, in unselected patient series, the incidence of urethral recurrence after cystoprostatectomy is estimated to be about 10%.3 It should be clear that all patients with transitional cell carcinoma of the bladder are at risk for tumour recurrence in the remnant urethra.1

The risk factors for metachronous urethral tumour recurrence have been identified on the basis of retrospective clinical studies.3 Some authors have clearly demonstrated that the incidence of urethral recurrence after cystoprostatectomy is much higher (reaching 37%) in patients presenting with invasion ofthe bladder neck or ofthe prostatic urethra.4-6 A much lower incidence of recurrence (3-7%) has been found in patients with multiple tumours, or those with multifocal carcinoma in situ.4-8 This incidence is only slightly higher than that reported after cystectomy for solitary tumours (3-4%).5,6,8 Involvement of the urothelium of the ureters has also been described as an indicator for eventual urethral involvement.4

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