| Abstract: |
Purpose: To determine (1) the incidence of urethral transitional cell carcinoma in a large cohort of men undergoing cystoprostatectomy for bladder cancer, (2) the prognostic implications of clinical transitional cell carcinoma of the urethra subsequent to cystoprostatectomy and (3) the response to treatment, and (4) the incidence of other extravesical tumor sites associated with urethral cancer.Patients and Methods: Four hundred sixty-one male patients were treated by cystoprostatectomy at Memorial Sloan-Kettering Cancer Center between 1961 and 1973. These were reviewed and separated into three groups. Group 1 included 110 patients who underwent cystectomy and simultaneous urethrectomy that was termed prophylactic because no recognized anterior urethral abnormalities were present at the time of surgery. The indications for simultaneous urethrectomy included multiple neoplasms or neoplasms encroaching on the bladder neck or prostatic urethra. The incidence of clinically unsuspected histological abnormalities was noted. Group 2 included 27 patients who had therapeutic urethrectomy for clinically evident anterior urethral neoplasm. Three patients had cystectomy and simultaneous urethrectomy, whereas 24 had delayed urethrectomy. Urethral washings for cytology were available for some of these patients. Group 3 included 324 patients who had cystectomy alone. Subsequent tumors developing in the upper collecting system, and tumors appearing in the perineum, groin, and meatus were recorded for these three groups.Results: In group 1, unrecognized anterior urethral epithelial changes were present in 12.5% of patients having prophylactic urethrectomy (5 carcinoma in situ and 9 marked dysplasia). Eight of the 110 patients in this group developed upper tract tumors. Five were among the 14 (34%) patients with urethral abnormalities, and three were among the remaining 96 (3%). In group 2, 24 patients had therapeutic urethrectomy subsequent to cystectomy. Bloody discharge was most the most frequent sign of transitional cell carcinoma of the urethral remnant. In three removed urethras, no tumor was found, but these three patients later presented with carcinoma in the retained fossa navicularis. Urethral washings for cytology were performed in 15 cases and tested positive in 14. Four of the 27 patients (15%) developed upper tract transitional cell carcinoma, and two additional patients repeatedly shed malignant cells in the ileal conduit urine. In group 3, 324 patients had cystectomy alone without clinical evidence of urethral tumor, and five (1.5%) had upper tract tumors subsequent to cystectomy. Copyright © 1997 by W.B. Saunders Company |
