Indications to urethrectomy

In absence of tumour in anterior or posterior urethra, the indication to urethrectomy are controversial. Urologists are nowadays willing to find reasons why only a minority of their patients should undergo simultaneous urethrectomy. Some urologists fear extending the time of an already long radical procedure in order to perform simultaneous urethrectomy. Also, as already mentioned, some authors are convinced that a urethral recurrence can be detected early, permitting a subsequent effective therapy. However, when the urethra remains intact without function after cystoprostatectomy, it presents a risk as a likely site for tumour recurrence, and a close surveillance of the urethra (washing urethral cytology) is recommended.

A more important factor in the last decade is the availability of procedures for successful reconstruction of the lower urinary tract. Bladder substitution procedures in male, and more recently in female, patients have become routine practice and the presence of the urethra is of pivotal importance in the overall management of the patient. A new trend towards potency-sparing cystectomy is also going against urethrectomy as it has been shown that resection of the urethra significantly impairs sexual function.9-11 Finally, it has been reported that simultaneous urethrectomy increases morbidity, or gives rise to perineal pain and delayed mobilization and therefore carries an increased risk of thromboembolic complications.12,13

It is, therefore, vital to identify pre-operatively those patients who are at risk of developing a recurrence in the remnant urethra. Unfortunately, there is at present no prospective study on the use of prophylactic urethrectomy.

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