Surgical Management of Bone Metastases in Bladder Cancer: A Single-Center Retrospective Study

Bladder cancer (BC) frequently spreads to the bone, resulting in skeletal-related events with a major effect on quality of life. Since surgical treatment for bone metastases (BM) in BC patients remains understudied, we aimed to evaluate the outcome of surgery in a case series of 20 consecutive patients.

A retrospective of BC patients surgically treated for BM at our center between 2007 and 2024. Patient characteristics, surgical procedures, and outcomes, as well as postoperative survival, were analyzed.

Of the 20 patients with BC, who were operated for BM, 14 (70%) were male, with a median age at diagnosis of BM of 72 years. The femur was the most commonly metastatic site (55%), followed by the pelvis (20%) and tibia (15%). The median time between BC diagnosis and surgery for BM was 18 months, and the most frequent event was a complete pathological fracture (70%). Prosthetic joint reconstruction was used for 10 (50%) of our patients, making it the most commonly used procedure in our cohort. Seven patients experienced postoperative complications, and two underwent reoperation. Median postoperative survival was 2 months, and only two patients were alive at last follow-up, both of them presenting with BM many years after initial BC diagnosis.

Most BM in BC are in the lower extremity and pelvis and are lytic in character. The oncological outcome is poor, with short postoperative survival. The choice of surgical method should take into account the generally palliative stage of the disease. Patients presenting with late BM may have a better prognosis and thus benefit from more advanced surgical reconstruction. Surgery can provide symptomatic relief and structural stabilisation, but the risk for postoperative complications is considerable.