Management of the urethra in patients undergoing radical cystectomy for bladder carcinoma

Urethral carcinoma recurrence after radical cystectomy for bladder carcinoma is a rare but devastating condition. Among 140 male patients submitted to radical cystectomy, urethral carcinoma recurrence occurred in 11. Nine of whom died. Nine other patients underwent urethrectomy at the time of cystectomy or shortly afterwards. Five are alive with no evidence of disease, 4 died of local recurrence or distant metastasis. Prophylactic urethrectomy should be performed in the presence of carcinoma in situ in the prostatic urethra or involvement of the prostatic urethra from the bladder tumor. These criteria should be considered as an absolute contraindication for substitution enteroplasty.