The risk factor for urethral recurrence after radical cystectomy in patients with transitional cell carcinoma of the bladder.
OBJECTIVE
We evaluated the incidence and risk factors for urethral recurrence following radical cystectomy and urinary diversion in transitional cell carcinoma.


METHODS
A retrospective review was performed of the 412 consecutive patients who underwent radical cystectomy and urinary diversion for transitional cell carcinoma of the bladder between 1986 and 2004. A total of 294 patients were enrolled in this study. We investigated the impact of various clinical and pathological features on urethral recurrence by univariate and multivariate analysis.


RESULTS
Urethral recurrence developed in 13 patients (4.4%) and the 5-year urethral recurrence-free probability was 94.9%. On univariate analysis, positive urethral margin, prostatic stromal invasion, and prostatic urethral involvement had a significant influence on urethral recurrence (p < 0.05). The other clinical and pathological features were not significantly associated with urethral recurrence (p > 0.05). A multivariate Cox proportional hazard model revealed that a positive urethral margin (hazards ratio (HR) = 18.33, p < 0.001), prostatic urethral involvement (HR = 7.95, p < 0.001), and prostatic stromal invasion (HR = 5.80, p = 0.018) were independent risk factors for urethral recurrence.


CONCLUSIONS
A positive urethral margin is considered an absolute indication for prophylactic urethrectomy. In addition, more careful patient selection is necessary for orthotopic urinary diversion in patients with prostatic urethral involvement and prostatic stromal invasion.
Department of Urology, Yonsei University College of Medicine, Seoul, Korea.
Kang Su
KS
Cho
Joo Wan
JW
Seo
Sung Jin
SJ
Park
Young Hoon
YH
Lee
Young Deuk
YD
Choi
Nam Hoon
NH
Cho
Seung Choul
SC
Yang
Sung Joon
SJ
Hong
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy; D018572:Disease-Free Survival; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control*; D009367:Neoplasm Staging; D018579:Patient Selection; D016016:Proportional Hazards Models; D011467:Prostate / Q000473:pathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000473:pathology*; D014523:Urethral Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control*; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion