Short- and long-term issues regarding urethral management in male radical-cystectomy patients

Radical cystectomy remains the gold-standard therapy for invasive bladder cancer. Management of the urethra before, during, and after cystectomy, however, is still not standardized. Herein, the rationale for different management algorithms is given.

The literature remains inconsistent regarding the best diagnostic and therapeutic management of the urethra before and during cystectomy as well as afterwards. The risk of urethral recurrence may in fact be lower after orthotopic urinary diversion, but the evidence for this and other recommendations comes from retrospective series. Urethral recurrence, although uncommon, continues to have a poor prognosis, and the optimal follow-up regimen is unclear. The importance of lifelong follow-up is unquestioned.

Risk factors for urethral involvement/recurrence can be determined before, during, and after radical cystectomy. The best way to diagnose and predict who will recur, however, is still unknown, as is the optimal follow-up regimen and treatment for the remnant urethra. The type of urinary diversion may in fact influence disease recurrence, as it also affects possible therapy for patients with recurrence.