Urethrectomy in men with transitional cell carcinoma of bladder

Data on a selected group of 90 male patients who had total cystectomy for diffuse transitional cell carcinoma encroaching on the bladder neck and/or involving the prostatic urethra were studied in relation to the incidence of urethral involvement. Of the 59 patients who had only total cystectomy, 8 (13.5%) required a subsequent therapeutic urethrectomy for clinical anterior urethral carcinoma. Of the remaining 31 patients who underwent simultaneous prophylactic urethrectomy at the time of cystectomy, 2 (6.4%) had transitional cell carcinoma and 1 had moderate mucosal atypia of the anterior urethra. Although the remaining urethra constitutes a potential hazard for further tumor formation, only 1 of 10 patients with urethral carcinoma possibly died of urethral tumor recurrence. Therefore, the urologist has a choice either to follow the patient closely with cytologic urethral wash or to do a prophylactic urethrectomy, especially in patients who are difficult to follow-up closely.