Surgical treatment for urethral recurrence after ileal neobladder reconstruction in patients with bladder cancer

OBJECTIVE To report a retrospective study evaluating the management of superficial urethral recurrence after ileal neobladder construction in patients with bladder cancer. PATIENTS AND METHODS In 77 consecutive patients with ileal neobladder after radical cystectomy for invasive bladder cancer, urethral recurrence was evaluated and transurethral resection (TUR) used as an initial treatment for superficial urethral recurrence. Urethrectomy with urinary re-diversion was performed when further recurrence developed. RESULTS Four patients (5%) presented with a superficial urethral recurrence and all four were treated by TUR as initial therapy. One patient has had no evidence of recurrence after initial TUR, although the other three patients were later treated with salvage urethrectomy due to repeated urethral recurrence. As a result, the stage of urethral recurrence advanced from pTa to pT1-pT2 in two of the three patients. For urinary re-diversion, one patient had a conversion from a Studer pouch to an ileal conduit, using the afferent limb, and the other two were converted from a Hautmann pouch to a continent reservoir using the Appe-Mainz procedure. There was no evidence of metastasis or local recurrence in any of the four patients. CONCLUSION Urethral preservation at initial therapy for superficial recurrence might be reasonable, and sequential urethrectomy after attempted urethral preservation might be strategically feasible. Urinary re-diversion from a neobladder to a catheterizable continent reservoir using the appendix would be a good choice and maintains the quality of life.