Urethral recurrence in patients following orthotopic urinary diversion

We present our experience with urethral recurrence of transitional cell carcinoma following cystectomy and orthotopic urinary diversion in a contemporary series.

Between June 1995 and December 2001, 415 patients underwent radical cystectomy for transitional cell carcinoma. Of those patients 196 (47.2%) received an orthotopic urinary diversion. Demographics, clinical characteristics, pathological stage and patient outcomes were reviewed.

Mean followup was 34.1 months (range 0.3 to 97.3). Of the 196 patients who underwent orthotopic diversion 59 (30.1%) had T3 or greater disease on final pathological evaluation. Thirteen patients (6.6%) were found to have prostatic urethral involvement while 83 (42.3%) had elements of carcinoma in situ. No patient with prostatic urethral involvement had subsequent urethral recurrence. Overall only 1 patient (0.5%) had urethral recurrence of transitional cell carcinoma following orthotopic urinary diversion. The urethral recurrence rate in patients with orthotopic diversion was less than in patients with ileal conduit creation during the same period (2.1%). The overall disease recurrence rate following orthotopic diversion was 31.6% (62 of 196).

Urethral recurrence following orthotopic neobladder was rare in this series despite using selection criteria that were less stringent than those of other comparable series. Overall disease recurrence was relatively high in patients with high risk pathological features but urethral recurrence in this group with orthotopic urinary diversion remained low.