Conflicting data exist regarding predictors of urethral recurrence (UR) following radical cystectomy (RC) as well as variables associated with survival in patients who experience UR.
To evaluate the incidence, risk factors, and outcomes of patients with UR.
Design, setting, and participants
We reviewed 1506 patients who underwent RC to identify patients with UR. Median follow-up after RC was 13.5 yr (interquartile range [IQR]: 10.5–18.4).
Cox proportional hazard regression models were used to analyze predictors of UR and evaluate factors associated with death from urothelial carcinoma (UC) in patients who experienced UR. Cancer-specific survival (CSS) for patients with UR, stratified according to the mode of diagnosis (abnormal urethral cytology vs symptoms), was estimated using the Kaplan-Meier method and compared with the log-rank test.
Results and limitations
UR was identified in 85 patients (5.6%) at a median of 13.3 mo (IQR: 6.1–23.2) after RC, including 80 of 1243 (6.4%) who underwent cutaneous urinary diversion and 5 of 242 (2.1%) who received an orthotopic neobladder (p
Prostate involvement with UC, tumor multifocality, and type of urinary diversion are significantly associated with UR following RC. Although UR is relatively uncommon, the detection of asymptomatic UR was associated with significantly lower stage disease and improved patient survival, suggesting the importance of continued postoperative evaluation of the urethra.
Keywords: Bladder cancer, Radical cystectomy, Urethra, Recurrence, Urothelial carcinoma.
a Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA
b Department of Pathology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA
c Department of Health Sciences Research, Mayo Medical School and Mayo Clinic, Rochester, MN, USA
Presented in podium format at the 2011 annual meeting of the American Urological Association, Washington, DC.
© 2011 European Association of Urology, Published by Elsevier B.V.