[Indications and techniques in urethrectomy]

The indications for urethrectomy during cystectomy for bladder cancer have substantially changed during the last years. Many years ago, prophylactic urethrectomy was performed in most patients undergoing cutaneous diversion. Today, transitional cell carcinoma at the level of the prostatic urethra or at the bladder neck is recognized to be the most important risk factor of urethral recurrence. Since the development of bladder substitutions, the indications for prophylactic urethrectomy have been dramatically reduced. Pre - and intra operative evaluation of the prostatic urethra in men and that of the bladder neck in women is the major determinant in the appropriate treatment strategy for the urethra in patients with bladder cancer.