Patterns, risks and outcomes of urethral recurrence after radical cystectomy for urothelial cancer; over 20 year single center experience

Purpose: To evaluate the factors affecting urethral recurrence after radical cystectomy for bladder cancer and relationship between urinary diversion type and urethral recurrence rates. Patients and methods: In our 504 radical cystectomy series, 287 male patients whose final pathological were urothelial carcinoma were included in the study. The relationship between urethral recurrence and pathological stage, grade, lymph node involvement and diversion type was researched in addition to risk factors for urethral recurrence. Results: A Total of 287 patients. Orthotopic continent urinary diversion (OCD) and ileal conduit (IC) was performed after radical cystectomy in 141 (49.1%) and 146 (50.9%) patients respectively. Urethral recurrence was observed in 11 (3.8%) patients and urethral recurrence rates in OCD and IC groups were 1.4% and 6.2% (p = 0.034). Pathological stages of recurrent patients were 2 pT1, 1 pT2 and 8 pT4 respectively (p < 0.001). Urethral recurrence was significantly lower in OCD group when compared to IC group (p = 0.036). When all parameters were analyzed using Cox multivariate regression analysis, the most important factor that affects urethral recurrence was pathological T stage (p < 0.001). Risk factors for urethral recurrence were present in 92 patients. Urethral recurrence rates in patients with and without risk factors were 8.69% and 1.53% (p < 0.01). Conclusions: In this study, pathological stage was found to be the most important factor affecting urethral recurrence and prostatic stromal invasion was an important prognostic factor in these cases. Although risk factors for urethral recurrence were similar in both groups, urethral recurrence rates were significantly lower in OCD group when compared to IC group. (C) 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.