Significance of prophylactic urethrectomy at the time of radical cystectomy for bladder cancer

Abstract

Background Prophylactic urethrectomy at the time of radical cystectomy is frequently recommended for patients with bladder cancer at a high risk of urethral recurrence without definitive evidence. The present study attempted to clarify the survival benefits of performing prophylactic urethrectomy. Methods We identified 214 male patients who were treated by radical cystectomy with an incontinent urinary diversion in our seven institutions between 2004 and 2017. We used propensity score matching and ultimately identified 114 patients, 57 of whom underwent prophylactic urethrectomy (prophylactic urethrectomy group) and 57 who did not (non-prophylactic urethrectomy group). Results No significant differences were observed in the 5-year overall survival rate between the prophylactic urethrectomy and non-prophylactic urethrectomy groups in the overall. However, the local recurrence rate was significantly lower in the prophylactic urethrectomy group than in the non-prophylactic urethrectomy group (P = 0.015). In the subgroup of 58 patients with multiple tumours and/or concomitant carcinoma in situ at the time of transurethral resection of bladder tumour, the 5-year overall survival rate was significantly higher in the prophylactic urethrectomy group than in the non-prophylactic urethrectomy group (P = 0.021). A multivariate analysis revealed that performing prophylactic urethrectomy was the only independent predictor of the overall survival rate (P = 0.016). In those patients who were treated without neoadjuvant chemotherapy (n = 38), the 5-year overall survival rate was significantly higher in the prophylactic urethrectomy group than in the non-prophylactic urethrectomy group (P = 0.007). Conclusions Prophylactic urethrectomy at the time of radical cystectomy may have a survival benefit in patients with multiple tumours and/or concomitant carcinoma in situ, particularly those who do not receive neoadjuvant chemotherapy.

Urethrectomy at the time of radical cystectomy for non-metastatic urothelial carcinoma of the bladder: a collaborative multicenter study

“…Our analyses indicated improved PFS after urethrectomy at the time of RC in patients at high risk for UR. Similarly, Hakozaki et al reported the survival benefit of prophylactic urethrectomy in patients at high UR risk (multiple tumors and/or concomitant CIS) [ 7 ]. Interestingly, that survival benefit was also found in patients who did not receive neoadjuvant chemotherapy (NAC) [ 7 ].…”

“…Similarly, Hakozaki et al reported the survival benefit of prophylactic urethrectomy in patients at high UR risk (multiple tumors and/or concomitant CIS) [ 7 ]. Interestingly, that survival benefit was also found in patients who did not receive neoadjuvant chemotherapy (NAC) [ 7 ]. It can be hypothesized that patients at high risk for UR are more likely to benefit from NAC for downstaging and improving oncological outcomes, especially in those planned to spare urethra (e.g., ONB diversion).…”

Technique of en bloc resection of the membranous urethra and bladder during robot‐assisted radical cystectomy in patients without simultaneous urethrectomy

“…5 Furthermore, it was reported that prophylactic urethrectomy at the time of RC might offer a survival benefit in patients with multiple tumors and/or concomitant carcinoma in situ, particularly those who do not receive neoadjuvant chemotherapy. 6 Therefore, performing prophylactic urethrectomy at the time of RC might be recommended for patients with multiple tumors and/or concomitant carcinoma in situ, prostatic involvement, previous history of non-MIBC, and positive frozen sections of the urethral margin. 5,6 The European Association of Urology and the National Comprehensive Cancer Network guidelines do not address prophylactic urethrectomy during RC when the creation of a neobladder is not being considered for urinary diversion in detail.…”

Micropapillary bladder cancer: an added indication to prophylactic urethrectomy

“…Hakozaki et al. [ 4 ] found that prophylactic urethrectomy was the only independent predictor of overall survival in patients with multiple bladder tumours and/or concomitant carcinoma in situ that were treated without neoadjuvant chemotherapy. Van Poppel and Thuer [ 8 ] recommended the use of prostatic urethral involvement in men and bladder neck involvement in women as the only indication for prophylactic urethrectomy.…”

“…Prophylactic urethrectomy at time of radical cystectomy is debatable and not routinely done by most urologic oncologists. A recent study (2021) found a survival benefit for prophylactic nephrectomy to patients that had multiple bladder tumours or concomitant carcinoma in situ at time of the transurethral resection [ 4 ]. Older studies found no significant survival benefits for prophylactic urethrectomy [ 5 ].…”