Incidence of urethral involvement in female bladder cancer: an anatomic pathologic study.
OBJECTIVE
To evaluate risk factors for urethral involvement in female patients undergoing cystectomy for bladder cancer and to define potential candidates for orthotopic continent urinary diversion.


METHODS
From 1990 to 1996, 43 female patients underwent cystectomy for primary bladder malignancy. Bladder mapping studies were performed with special attention to tumor location, multifocality, pathologic stage and grade, presence of carcinoma in situ (CIS), and the relationship of these factors to urethral involvement.


RESULTS
Of the 43 patients evaluated, 7 (16.3%) had urethral involvement by tumor. Two patterns of urethral invasion were identified: 5 patients had tumors in the vascular or lymphatic channels of the periurethral tissue, and 2 had tumors in the mucosa or submucosa. Three of the 12 patients with tumors located at the trigone and 4 of the 26 with CIS of the bladder had tumor in the urethra. Three of the 5 patients with vaginal involvement had tumor in the urethra. Only vaginal involvement was significantly associated with urethral involvement (P = 0.02).


CONCLUSIONS
Vaginal involvement was the only preoperative factor that was associated with presence of tumor in the urethra. Five patients with urethral involvement had submucosal tumors without concomitant CIS of the urethra. Before the performance of orthotopic urinary diversions, intraoperative full-thickness bladder neck biopsies are needed to accurately evaluate the female urethra.
Maralani
S
S
Karmanos Cancer Institute and Department of Urology, Wayne State University, Detroit, Michigan 48201, USA.
Wood
D P
DP
Grignon
D
D
Banerjee
M
M
Sakr
W
W
Pontes
J E
JE
D015653:Cystectomy; D005260:Female; D006801:Humans; D015994:Incidence; D009361:Neoplasm Invasiveness; D009378:Neoplasms, Multiple Primary / Q000453:epidemiology* / Q000473:pathology; D012307:Risk Factors; D014523:Urethral Neoplasms / Q000453:epidemiology* / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery