Patterns, risks and outcomes of urethral recurrence after radical cystectomy for urothelial cancer; over 20 year single center experience

Balcı, Uğur; Doğantekin, Engin; Ozer, Kutan; Görgel, Sacit Nuri; Girgin, Cengiz; Dinçel, Çetin

doi:10.1016/j.ijsu.2014.12.006

Cited by 23 publications

(23 citation statements)

References 31 publications

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“…A number of studies have tried to address this issue in recent years. In these series, prostatic urethral [10,12] and stromal [14] involvement, tumor multifocality [10], pathological T-stage [15], especially nonmuscle invasive tumor stage (Ta, Tis, T1) [11], performance of nonorthotopic diversions [10], and a positive final urethral margin at RC [14] have been independently associated with secondary urethral carcinoma. In this regard, the rate of secondary urethral tumors in men with stage T4a disease treated with RC and orthotopic bladder substitution (OBS) was found to be only 6%.…”

Section: Evidence Synthesismentioning

confidence: 99%

“…Interestingly, large studies have reported that patients with OBS are at a significantly lower risk for secondary urethral malignancy compared to those with nonorthotopic diversions [10,15]. Of the 224 patients with urethral recurrence (Table 1), 71 (31.7%) were found in patients with orthotopic bladder substitutes compared with 153 (68.3%) in patients with nonorthotopic bladder substitutes.…”

Section: Evidence Synthesismentioning

confidence: 99%

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Systematic Review on the Fate of the Remnant Urothelium after Radical Cystectomy

et al. 2017

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Context Urothelial carcinoma is considered a pan-urothelial disease. As such, the remnant urothelium in the upper urinary tract and urethra following radical cystectomy (RC) remains at risk for secondary urothelial tumors (SUTs). Objective To describe the incidence, diagnosis, treatment, and outcomes of patients with SUTs after RC. Evidence acquisition A systematic search was conducted using PubMed database according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify studies between 1970 and 2016 reporting on malignant diseases of the urothelium after RC for bladder cancer. The search strategy separated between upper and lower tract urothelial tumors. Evidence synthesis Of a total of 1069 studies, 57 were considered for evidence synthesis. SUTs occured in approximately 4–10% of patients after RC. Carcinoma in situ of the bladder, a history of nonmuscle invasive bladder cancer, and tumor involvement of ther distal ureter are the strongest risk factors for secondary upper tract tumors. Risk factors for secondary urethral tumors represent urothelial malignancy in the prostatic urethra/prostate and bladder neck (in women), nonorthotopic diversions, and positive findings on permanent sections. The majority of patients (84%) with SUTs, presented with urothelial recurrence without evidence of metastasis. Of those, 84.0% were treated with surgery, 10.5% with systemic chemotherapy and/or radiotherapy, and 5.6% with topical chemotherapy and/or immunotherapy. After a median follow-up of 91 mo (range: 26–155), 65.9% of patients died of disease and 21.5% died of other causes. Detection and treatment of SUTs at an asymptomatic stage can reduce the risks of cancer-specfific and overall mortality by 30%. A limitation of the study is that the available data were retrospective. Conclusions SUTs are rare oncological events and most patients have an adverse prognosis despite absence of distant disease at diagnosis. Therefore, surveillance of the remnant urothelium should be implemented for patients with histological features of panurothelial disease as it may improve timely detection and treatment. Patient summary Secondary tumors of the renal pelvis, ureters, and urethra occur in approximately 4–10% of patients after radical removal of the bladder for bladder cancer. These patients’ prognoses are reduced, likely due to delayed diagnosis. Therefore, routine surveillance might be important to detect tumors at an early stage.

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Section: Evidence Synthesismentioning

confidence: 99%

Section: Evidence Synthesismentioning

confidence: 99%

Systematic Review on the Fate of the Remnant Urothelium after Radical Cystectomy

et al. 2017

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“…The incidence of urethral (6.8%) and UUT (2.3%) recurrence after RC was consistent with previous findings. [4][5][6][7][8][9][10]16,19,31 We observed a statistical trend toward a lower rate of urethral recurrence after orthotopic reconstruction than after cutaneous diversion (5.7% vs. 8.1%). 5,7,24,29 The correct protocol and timing of surveillance after RC continue to be debated, with conflicting evidence reported.…”

Section: Discussionmentioning

confidence: 54%

“…[14][15][16][17] Moreover, the type of urinary diversion, involvement of the prostate and bladder neck, tumor multifocality, pathologic stage, and anterior vaginal wall infiltration in women appear to be associated with a greater risk of urethral recurrence. 7,14,[17][18][19][20][21] The exact schedule for surveillance of the remnant urothelium after RC has been debated. To the best of our knowledge, no established or standardized guidelines exist for determining the correct schedule for surveillance.…”

Section: Introductionmentioning

confidence: 99%

Effect of Urinary Cytology for Detecting Recurrence in Remnant Urothelium After Radical Cystectomy: Insights From a 10-year Cytology Database

Pichler

Tulchiner

Oberaigner

et al. 2017

Clinical Genitourinary Cancer

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“…As recurrence can involve the entire urinary tract, the urethra also needs to be screened, often with urethral wash cytology, although urethral recurrence may occasionally be identified on cross-sectional imaging. The risk of urethral recurrence is 2.7% to 3.8%, and risk factors include prostatic involvement of the MIBC [46][47][48].…”

Section: Variant 3: Muscle-invasive Bladder Cancer (Mibc) With or Witmentioning

confidence: 99%

ACR Appropriateness Criteria® Post-Treatment Surveillance of Bladder Cancer

Imaging¹,

Allen

Oto

et al. 2019

Journal of the American College of Radiology

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Patterns, risks and outcomes of urethral recurrence after radical cystectomy for urothelial cancer; over 20 year single center experience

Cited by 23 publications

References 31 publications

Systematic Review on the Fate of the Remnant Urothelium after Radical Cystectomy

Systematic Review on the Fate of the Remnant Urothelium after Radical Cystectomy

Effect of Urinary Cytology for Detecting Recurrence in Remnant Urothelium After Radical Cystectomy: Insights From a 10-year Cytology Database

ACR Appropriateness Criteria® Post-Treatment Surveillance of Bladder Cancer

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