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Prepubic urethrectomy during radical cystoprostatectomy.

Steven Joniau¹, Waleed Shabana, Bjorn Verlinde

¹Department of Urology, University Hospitals Leuven, Leuven, Belgium.

European Urology

|October 31, 2006

Summary

Prepubic urethrectomy is a feasible surgical option for muscle-invasive bladder cancer patients undergoing cystectomy, offering a simpler and quicker approach with manageable complications compared to other methods. This technique helps reduce urethral recurrence risk.

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Area of Science:

Urology
Surgical Oncology

Background:

Muscle-invasive bladder cancer (MIBC) necessitates cystectomy, with urethral recurrence risk ranging from 4-18% post-cystectomy, particularly with ileal conduit diversion.
Urethrectomy is sometimes recommended for MIBC to mitigate urethral recurrence.
The prepubic urethrectomy technique was developed to address this surgical challenge.

Purpose of the Study:

To assess the feasibility and implications of the prepubic urethrectomy technique.
To evaluate the operative time, complications, and overall outcomes of this surgical approach over a 20-year period.

Main Methods:

Retrospective analysis of 180 consecutive male patients undergoing simultaneous cystectomy and prepubic urethrectomy for MIBC (1985-2005).
Detailed description of the prepubic urethrectomy technique.

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Documentation of technical difficulties and postoperative complications.

Main Results:

The mean operative time increased by 17 minutes with prepubic urethrectomy.
Overall postoperative complications occurred in 5.5% of patients.
Hematomas (penile and scrotal) were the most common complications, generally managed conservatively or with minor surgical intervention; no thromboembolic or neurologic complications were observed.

Conclusions:

Prepubic urethrectomy is a feasible and effective surgical option for indicated cases of MIBC.
This approach is simpler and less time-consuming than the perineal approach.
The prepubic technique offers limited and manageable complications, making it a valuable surgical choice.