Tumor Recurrence in the Remnant Urothelium of Females Undergoing Radical Cystectomy for Transitional Cell Carcinoma of the Bladder: Long-Term Results From a Single Center

Abstract

Recurrent or multifocal TCC may represent a risk factor for secondary TCC of the remnant urothelium after cystectomy. In our series all recurrent tumors were late recurrences (more than 36 months postoperatively). Because the rate of urethral recurrence in the current series corresponds to that reported in men (2% to 6%), urethra sparing cystectomy with orthotopic bladder replacement does not appear to compromise the oncological outcome in women.

Management of the urethra in urothelial bladder cancer

“…[7][8][9][10] Women seem to have at least comparable UR rates in contemporary series, ranging from 4.7% to 12%. 5,11,12 Interestingly, recurrence rates have also been shown to vary by type of diversion performed. In patients with cutaneous urinary diversions, recurrence rates range from 2.1% to 11.1%, while in those with orthotopic bladder substitutions, recurrence rates are slightly lower at 0.5% to 4.3%.…”

“…[7][8][9][10][11]13,14 Median time to recurrence ranges from 12.8 to 56 months across studies, but most patients recur within 3 years. [7][8][9][10][11] There are reports of delayed recurrences at 10 and 20 years, thus highlighting the importance of proper lifelong monitoring. 1 In one study comparing ileal conduits to neobladders, average recurrence time was 2 years and no significant difference was found between the 2 groups.…”

“…9 Based on one study where all female recurrences occurred more than 3 years after cystectomy, it appears that recurrence may occur later in women. 11 This has been postulated to be due to the shorter length of remnant urothelium, or due to the process of aging resulting in cranial migration of metaplastic squamous cell mucosa in the urethra, which may have a protective effect. 5 …”

“…18 In a recent univariate analysis, Akkad and colleagues found that multifocality and tumour at the bladder neck predicted urethral recurrence, whereas CIS and nodal status did not. 11 In a retrospective review of 356 females in the same year, Stenzl and colleagues reported that 2% of specimens had urethral involvement at initial presentation, and that tumour at the bladder neck (p < 0.0001) and trigone (p < 0.035) were most often the regions of primary tumour in these patients. They concluded that the only consistent risk factor is bladder neck involvement.…”

“…There is no consensus on optimal monitoring technique or timing regimen, but many authors advocate at least biannual exams for the first 3 years, with decreasing frequency thereafter. 1,7,9,11,14 Some studies included comparisons of surveillance techniques. Data from USC suggested that symptomatic presentation occurred later, with a median recurrence time of 30.9 months, versus 11.6 months for those presenting with positive cytology.…”