The value of cystoscopy, prostate biopsy and frozen-section urethral biopsy prior to orthotopic neobladder substitution.
BACKGROUND
The traditional criteria for selecting suitability of male patients with bladder cancer for othtopic neobladder substitution includes: patient motivation, negative transurethral (TUR) prostate biopsy prior to cystectomy, and/or tumor-free biopsy of the urethral margin at the time of cystectomy. In this report we evaluate the value of these preoperative and intraoperative biopsies in the cystoscopically normal prostatic urethra.


METHODS
During a 5-year period, cystectomies were performed on 54 men and 13 women with invasive bladder cancer. Prior to this procedure, all of the men had TUR biopsy of the prostate. Forty men with cystoscopically normal prostatic fossa had negative prostatic biopsies, and. had orthotopic neobladder substitution.


RESULTS
Pathological examination showed that 3 out of these 40 men had transitional cell carcinoma (TCC) involving the prostate. In all 40 patients, the prostatic apical resection margin was negative. To date, none of the patients developed urethro-neobladder recurrence.


CONCLUSIONS
TUR biopsy of the prostatic urethra prior to cystectomy, or biopsy of the prostatic urethral margin at the time of cystectomy in patients with cystoscopically normal, tumor free prostatic urethra has limited value in selecting candidates for orthotopic neobladder substitution.
Bulbul
M A
MA
Department of Surgery, Division of Urology, American University of Beirut, Beirut, Lebanon.
Wazzan
W
W
Nasr
R
R
Hemady
K
K
D000328:Adult; D000368:Aged; D001706:Biopsy; D003558:Cystoscopy; D005260:Female; D005629:Frozen Sections; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011467:Prostate / Q000473:pathology*; D014521:Urethra / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D016476:Urinary Reservoirs, Continent