Urethral recurrence in women with orthotopic bladder substitutes: A multi-institutional study.
OBJECTIVE
To evaluate risk factors for urethral recurrence (UR) in women with neobladder.


METHODS
From 1994 to 2011, 297 women (median age = 54 y; interquartile range: 47-57) underwent radical cystectomy with ileal neobladder for bladder cancer in 4 centers. None of the patients had bladder neck involvement at preoperative assessment. Univariable and multivariable analyses were used to estimate recurrence-free survival and overall survival. The median follow-up was 64 months (interquartile range: 25-116).


RESULTS
Of the 297 patients, 81 developed recurrence (27%). The 10- and 15-year recurrence-free survival rates were 66% and 66%, respectively. The 10- and 15-year overall survival rates were 57% and 55%, respectively. UR occurred in 2 patients (0.6%) with solitary urethral, 4 (1.2%) with concomitant urethral and distant recurrence, and 1 with concomitant urethral and local recurrence (0.3%). Bladder tumors were located at the trigone in 27 patients (9.1%). None of these patients developed UR. Lymph node tumor involvement was present in 60 patients (20.2%). On univariable and multivariable analyses, pathologic tumor and nodal stage were independent predictors for the overall risk of recurrence. UR was associated with a positive final urethral margin status (P<0.001) whereas no significant associations were found for carcinoma in situ, pathologic tumor and nodal stage, and bladder trigone involvement.


CONCLUSIONS
In this series, only 0.6% of women developed solitary UR. A positive final urethral margin was associated with an increased risk of UR. Women with involvement of the bladder trigone were not at higher risk of UR.
Department of Urology, University Hospital Tübingen, Tübingen, Germany. Electronic address: georgios.gakis@googlemail.com.
Georgios
G
Gakis
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Bedeir
B
Ali-El-Dein
2nd Faculty of Medicine, Charles University, Prague, Czech Republic.
Marko
M
Babjuk
2nd Faculty of Medicine, Charles University, Prague, Czech Republic.
Jan
J
Hrbacek
1st Faculty of Medicine, Charles University, Prague, Czech Republic.
Petr
P
Macek
Department of Urology, University of Bern, Bern, Switzerland.
Fiona C
FC
Burkhard
Department of Urology, University of Bern, Bern, Switzerland.
George N
GN
Thalmann
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Atallah-Abdel
AA
Shaaban
Department of Urology, University Hospital Tübingen, Tübingen, Germany.
Arnulf
A
Stenzl
D000328:Adult; D000368:Aged; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D001743:Urinary Bladder / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
Female; Neobladder; Radical cystectomy; Recurrence; Urethral