Micropapillary bladder cancer: an added indication to prophylactic urethrectomy.
Vahid Mehrnoush1, Asmaa Ismail1, Ahmed Zakaria1
1Department of Urology, Northern Ontario School of Medicine, TBRHSC, 980 Oliver Road, Thunder Bay, Ontario, P7B 6V4, Canada.
Concurrent urethrectomy during cystectomy may prevent urethral recurrence in micropapillary bladder cancer (MPBC). Two cases highlight the importance of considering urethrectomy in MPBC management to avoid later complications.
Area of Science:
- Urology
- Oncology
Background:
- Micropapillary bladder cancer (MPBC) is an aggressive subtype.
- The role of urethrectomy during cystectomy for MPBC is not well-established.
Observation:
- Two MPBC cases are presented: one female with T4a disease undergoing anterior pelvic exenteration and total urethrectomy, and one male with T1 disease initially treated with BCG, who later developed recurrent T2 MPBC after urethra-sparing cystoprostatectomy.
- The male patient subsequently underwent urethrectomy due to urethral bleeding, revealing micropapillary cancer in the urethra.
Findings:
- Pathology confirmed T4a micropapillary variant in the female patient.
- The male patient's delayed urethrectomy revealed urethral micropapillary cancer, indicating potential urethral seeding or involvement.
Implications:
- Concurrent urethrectomy during cystectomy may be a crucial preventive measure for MPBC patients.
- These cases suggest that sparing the urethra during radical cystectomy for MPBC might increase the risk of urethral recurrence.
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