Urethral involvement in female bladder cancer patients: mapping of 47 consecutive cysto-urethrectomy specimens

We reviewed 47 consecutive step-sectioned cysto-urethrectomy specimens of bladder cancer in female patients to determine the incidence and characteristics of urethral involvement. Of the 47 cases 43 were transitional cell carcinoma: 10 (23%) papillary, 9 (21%) papillo-nodular and 18 (42%) nodular cancer, and 6 (14%) primary or secondary carcinoma in situ. There were 23 cases (54%) of invasive carcinoma of more than stage pT1 and 27 (63%) were grade 3 lesions. Urethral cancer was observed in only 3 cases: 1 stage pT4, grade 3 papillo-nodular cancer developed widely in the bladder and, overriding the bladder neck and proximal urethra, stage pTa, grade 2 papillary cancer was detected, while in 2 with nodular invasive lesions of the bladder (including the bladder neck) urethral cancer was detected either as a direct invasive extension via urethral carcinoma in situ or as an intralymphatic spread without urethral mucosal change. These findings indicate the necessity for prophylactic urethrectomy in cases of papillary or papillo-nodular cancer encroaching on the bladder neck, and nodular invasive cancer infiltrating the bladder neck and trigone. In other cases, preservation of the urethra seems possible for bladder reconstruction in female bladder cancer patients to ensure normal voiding after cystectomy.