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

Abstract

Introduction The optimal management of the urethra in patients planned for radical cystectomy (RC) remains unclear. We sought to evaluate the impact of urethrectomy on perioperative and oncological outcomes in patients treated with RC for non-metastatic urothelial carcinoma of the bladder (UCB). Materials and methods We assessed the retrospective data from patients treated with RC for UCB of five European University Hospitals. Associations of urethrectomy with progression-free (PFS), cancer-free (CSS), and overall (OS) survivals were assessed in univariable and multivariable Cox regression models. We performed a subgroup analysis in patients at high risk for urethral recurrence (UR) (urethral invasion and/or bladder neck invasion and/or multifocality and/or prostatic urethra involvement). Results A total of 887 non-metastatic UCB patients were included. Among them, 146 patients underwent urethrectomy at the time of RC. Urethrectomy was performed more often in patients with urethral invasion, T3/4 tumor stage, CIS, positive frozen section analysis of the urethra, and those who received neoadjuvant chemotherapy, underwent robotic RC, and/or received an ileal conduit urinary diversion (all p < 0.001). Estimated blood loss and the postoperative complication rate were comparable between patients who received an urethrectomy and those who did not. Urethrectomy during RC was not associated with PFS (HR 0.83, p = 0.17), CSS (HR 0.93, p = 0.67), or OS (HR 1.08, p = 0.58). In the subgroup of 276 patients at high risk for UR, urethrectomy at the time of RC decreased the risk of progression (HR 0.58, p = 0.04). Conclusion In our study, urethrectomy at the time of RC seems to benefit only patients at high risk for UR. Adequate risk assessment of UCB patients’ history may allow for better clinical decision-making and patient counseling.

Case Report: Urothelial urethral carcinoma in HIV patient underwent total urethrectomy and perineal urethrostomy

“…Patients with UC at high risk may occasionally be candidates for this surgery as in this case. 16,17 This patient also underwent a surgical procedure called a perineal urethrostomy to make a permanent incision in the perineum's skin through which the urethra may be accessed. This procedure is carried out to overcome the urinary passage challenge after total urethrectomy.…”

Long-Term Cardiovascular Mortality among 80,042 Older Patients with Bladder Cancer

“…Nonetheless, the key result in our study is a phenomenal description but not a causal result, while anticancer therapy, cardiovascular risk factors, and comorbidities were majorly associated with the causes of the phenomenon. The SEER database did not have data on residual disease and positive surgical margins’ locations, and we could not further explore their impact on CVD death risk in older BC patients [ 47 , 48 ].…”

Neobladder “Function”: Tips and Tricks for Surgery and Postoperative Management

“…In the multicenter study conducted by Laukhtina et al [ 100 ], urethrectomy does not appear to improve survival outcomes (PFS, CSS, OS) in all patients treated with RC for urothelial bladder cancer. However, there was evidence of improvement in PFS after urethrectomy at the time of RC in patients at high risk of urothelial recurrence (papillary pattern, multiple tumors and/or concomitant CIS), as reported in a previous study by Hakozaki et al [ 101 ].…”