Risk of urethral, vaginal and cervical involvement in patients undergoing radical cystectomy for bladder cancer: results of a contemporary cystectomy series from M. D. Anderson Cancer Center.
OBJECTIVE
Orthotopic bladder reconstruction in women is the focus of considerable interest. To define suitable candidates for orthotopic reconstruction among women with bladder cancer, we reviewed the risk of secondary urethral, vaginal and cervical involvement by transitional cell carcinoma in patients who underwent radical cystectomy at our institution.


METHODS
We retrospectively reviewed the charts of women who underwent radical cystectomy for primary transitional cell carcinoma of the bladder between 1985 and 1995. These cases also were reviewed pathologically.


RESULTS
Of 115 patients who underwent radical cystectomy for transitional cell carcinoma of the bladder 9 (8%) also had secondary transitional cell carcinoma of the urethra, including 2 with concomitant involvement of the vagina or cervix. In 4 patients (3%) the vagina or cervix was involved but not the urethra. Vaginal and cervical invasion correlated with stages T3b and T4 disease (p = 0.04). By logistic regression analysis the sole significant risk factor for urethral involvement was bladder neck involvement (p = 0.0005). Unlike previous studies 2 of 9 patients with secondary urethral transitional cell carcinoma did not have apparent cancer at the bladder neck.


CONCLUSIONS
We report secondary urethral involvement without apparent bladder neck involvement in women with transitional cell carcinoma. Women who are candidates for orthotopic reconstruction should undergo biopsies of the bladder neck and urethra as part of the preoperative evaluation. In patients with palpable masses (stage T3b) on bimanual examination, transvaginal biopsies should also be considered. Intraoperative frozen sections of the urethral and vaginal margins should be obtained.
Chen
M E
ME
Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, USA.
Pisters
L L
LL
Malpica
A
A
Pettaway
C A
CA
Dinney
C P
CP
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D018288:Carcinoma, Small Cell / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009378:Neoplasms, Multiple Primary / Q000453:epidemiology*; D012307:Risk Factors; D014523:Urethral Neoplasms / Q000453:epidemiology*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology*; D014625:Vaginal Neoplasms / Q000453:epidemiology*