Immediate versus staged urethrectomy in patients at high risk of urethral recurrence: is there a benefit to either approach?
OBJECTIVE
To compare treatment-related outcomes of immediate and staged urethrectomy in patients at high risk of urethral recurrence.


METHODS
We retrospectively identified 76 male patients with cystectomy for transitional cell carcinoma of the bladder who had undergone urethrectomy in the absence of established urethral recurrence. Concomitant cystoprostatectomy and urethrectomy was performed in 57 patients and staged urethrectomy in 19 patients. The criteria for staged urethrectomy were the presence of a positive urethral margin or established transitional cell carcinoma of the urethra in the cystectomy specimen. The mean interval from cystectomy to staged urethrectomy was 4.7 months (range 1.4 to 14).


RESULTS
The most common pathologic finding of the urethrectomy specimens was prostatic duct involvement (31.6%) in the immediate urethrectomy group and Stage pT0 in the delayed urethrectomy group (73.7%). No statistically significant difference in disease-specific survival was noted between the immediate and staged groups (P = 0.14). Similarly, no difference was noted in postoperative complication rates or total operative blood loss (P = 0.77 and P = 0.64, respectively). However, a slight benefit for immediate urethrectomy was noted in the total duration of hospitalization (P = 0.01). The presence of local or distant recurrence was a predictor of disease-specific survival (P = 0.02 and P = 0.02, respectively).


CONCLUSIONS
Immediate and staged urethrectomy appear to be similar in surgical morbidity and disease-specific survival. A benefit was noted for the immediate group in the total duration of hospitalization. The development of local or distant recurrence was a predictor of poor survival.
Spiess
Philippe E
PE
Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
Kassouf
Wassim
W
Brown
Gordon
G
Highshaw
Ralph
R
Wang
Xuemei
X
Do
Kim-Anh
KA
Kamat
Ashish M
AM
Czerniak
Bogdan
B
Dinney
Colin P N
CP
Grossman
H Barton
HB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011468:Prostatectomy; D012307:Risk Factors; D013997:Time Factors; D014521:Urethra / Q000601:surgery*; D014523:Urethral Neoplasms / Q000517:prevention & control*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods