title: Management of urethral recurrence in patients with Studer ileal neobladder.
abstract: OBJECTIVE
  The overall risk of urethral recurrence (UR) of transitional cell carcinoma (TCC) in patients with orthotopic neobladder ranges from 2% to 6%. We are presenting herein our experience in order to evaluate and define the management of these patients, since the cases with urethral recurrence in patients with orthotopic neobladder are very scarce.
  
  
  METHODS
  Five hundred and sixteen radical cystectomies due to TCC were performed at our Centre between January 1990 and February 1998. One hundred and thirty-eight of them (26.7%) underwent an orthotopic neobladder procedure with the Studer's technique. We are reviewing five cases of UR in patients with orthotopic neobladder, the cystectomy indications and the differences between the clinical and the pathologic stages. We are also assessing its clinical presentation, diagnosis, treatment and evolution.
  
  
  RESULTS
  Five patients (3.6%) from 50 to 71 years old with Studer's orthotopic neobladder presented with UR. All of those neobladders were initially superficial TCC, mostly multifocal, and all had failed the endovesical treatment. Endoscopic treatment was administered in two cases with superficial UR. One patient with urethral CIS received intraurethral BCG instillations. One case because of multiplicity, and another due to the presence of an infiltrating urethral tumour, underwent urethrectomy and neobladder exeresis. In both cases, the intact 15-20cm isoperistaltic proximal ileal limb of the Studer-type orthotopic neobladder was used as an ileal conduit.
  
  
  CONCLUSIONS
  UR in patients with orthotopic bladder substitution is unusual. A conservative approach is possible when dealing with superficial recurrences. In cases of urethrectomy, the isoperistaltic proximal ileal limb of the Studer neobladder may be used as an ileal conduit.
authors.affiliation: Urology Department, Fundació Puigvert, Cartagena 340, 08025, Barcelona, Spain. secrecomun@fundacio-puigvert.es
authors.forename: Jorge
authors.initials: J
authors.lastname: Huguet
authors.forename: Juan
authors.initials: J
authors.lastname: Palou
authors.forename: Marc
authors.initials: M
authors.lastname: Serrallach
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Solé Balcells
authors.forename: José
authors.initials: J
authors.lastname: Salvador
authors.forename: Humberto
authors.initials: H
authors.lastname: Villavicencio
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D015653:Cystectomy; D006801:Humans; D008875:Middle Aged; D014523:Urethral Neoplasms / Q000556:secondary* / Q000628:therapy*; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery; D016476:Urinary Reservoirs, Continent