Management of urethral recurrence after orthotopic urinary diversion.
METHODS
Therapy (case series) Level of Evidence 4 OBJECTIVE To evaluate our experience with urethral recurrences in patients treated by radical cystectomy(RC) and orthotopic neobladder urinary diversion for carcinoma of the bladder.


METHODS
We retrospectively reviewed the records of patients treated with RC and orthotopic urinary diversion between January 1980 and July 2004.


RESULTS
In all, 260 patients underwent RC with a Studer or Hautmann orthotopic urinary diversion; the median (range) follow-up was 5.1 (0-15.6) years. Six patients (2.3%) developed local recurrence of urothelial cancer (UC) within the urethra after this treatment. The median (range) time to presentation with recurrence after RC was 2.4 (0.7-3.6) years for pT1-4 UC. Recurrences were treated with various methods, including transurethral resection, urethrectomy with conversion of neobladder to continent catheterizable diversion, and chemotherapy. At the last follow-up, four of these six patients were alive without disease, one was alive with disease, and one had died from disease.


CONCLUSIONS
In our experience, local recurrences involving the urethra are infrequent. Complete surgical excision can provide a good outcome. Neoadjuvant chemotherapy should be considered for recurrences with adverse clinicopathological features.
Taylor
Jennifer M
JM
Department of Urology and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Spiess
Philippe E
PE
Kassouf
Wassim
W
Munsell
Mark F
MF
Kamat
Ashish M
AM
Dinney
Colin P N
CP
Grossman
H Barton
HB
Pisters
Louis L
LL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D014523:Urethral Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D016476:Urinary Reservoirs, Continent