title: Treatment and outcomes of urethral recurrence of urinary bladder cancer in women after radical cystectomy and orthotopic neobladder: a series of 12 cases.
abstract: BACKGROUND
  The incidence, treatment, and outcome of urethral recurrence (UR) after radical cystectomy (RC) for muscle-invasive bladder cancer with orthotopic neobladder in women have rarely been addressed in the literature.
  
  
  METHODS
  A total of 12 patients (median age at recurrence: 60 years) who experienced UR after RC with an orthotopic neobladder were selected for this study from a cohort of 456 women from participating institutions. The primary clinical and pathological characteristics at RC, including the manifestation of the UR and its treatment and outcome, were reviewed.
  
  
  RESULTS
  The primary bladder tumors in the 12 patients were urothelial carcinoma in 8 patients, squamous cell carcinoma and adenocarcinoma in 1 patient each, and mixed histology in 2 patients. Three patients (25%) had lymph node-positive disease at RC. The median time from RC to the detection of UR was 8 months (range 4-55). Eight recurrences manifested with clinical symptoms and 4 were detected during follow-up or during a diagnostic work-up for clinical symptoms caused by distant metastases. Treatment modalities were surgery, chemotherapy, radiotherapy, and bacillus Calmette-Guérin urethral instillations. Nine patients died of cancer. The median survival after the diagnosis of UR was 6 months.
  
  
  CONCLUSIONS
  UR after RC with an orthotopic neobladder in females is rare. Solitary, noninvasive recurrences have a favorable prognosis when detected early. Invasive recurrences are often associated with local and distant metastases and have a poor prognosis.
authors.affiliation: Department of Urology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Hrbáček
authors.forename: Petr
authors.initials: P
authors.lastname: Macek
authors.forename: Bedeir
authors.initials: B
authors.lastname: Ali-El-Dein
authors.forename: George N
authors.initials: GN
authors.lastname: Thalmann
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
authors.forename: Marek
authors.initials: M
authors.lastname: Babjuk
authors.forename: Atallah A
authors.initials: AA
authors.lastname: Shaaban
authors.forename: Georgios
authors.initials: G
authors.lastname: Gakis
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D005060:Europe; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D012086:Reoperation; D012189:Retrospective Studies; D019738:Surgically-Created Structures; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019459:Urothelium / Q000187:drug effects / Q000473:pathology* / Q000528:radiation effects / Q000601:surgery