| BACKGROUND:Bladder cancer is one of the most common tumors in the urinary system, which has an incidence rate 3-4 times higher in male than female. Bladder cancer patients who are newly discovered, approximately 30%of which have been developed to the stage T2, and some have developed more than T2. Nowadays, radical cystectomy is considered as gold standard to manage invasive bladder cancer. Studies have reported that about one-third patients wouldexperience recurrence after radical cystectomy. Urethral recurrence is a rare recurrence type with a median incidence rate of 10%。Previous literatures reported that CIS, tumor multifocality, positions tumor invasived, urinary diversion type were risk factors for urethral recurrence after radical cystectomy, but the identification of risk factors for urethral recurrence in different studies is not identical to each other. Although the rate of urethral recurrence after radical cystectomy is low, it has a bad prognosis with median survival time 28 months. So EAU guideling recommend to conduct urethral follow-up regularly。Additionally, some literatures reports that regular urethral follow-up doesn’t haveastatistically significant effect on disease progression and disease-free survival。OBJECTIVE:To identify the risk factors for urethral recurrence after radical cystectomy, and relationship between urethral recurrence and risk factors. To discuss if it is significant to resect the urethra simultaneously and conduct a regular urethral follow-up after radical cystectomy.MATERIALS AND METHODS:we retrospectively reviewed the records of 138 consecutive patients who underwent radical cystectomy at our institute,and 99 male bladder transitional cell carcinoma patients were included.10 suspected factors associated with urethral recurrencewere extracted to conduct both univariate and multivariate logistic regression analysis aimed at confirming the significant factors.We evaluated the correlativity between significant factors and urethral recurrence to discuss whether resecting the urethra simultaneously is necessary.We stratified the patients based on the mode of urethral recurrence symptoms(asymptomatic vs symptomatic) and recorded the time from recurrence to the date on which he died from urethral recurrence. Kaplan-Meier method and log-rank test were used to compare survival rate after urethrectomy. Then discussed the necessity of regular urethral follow-up.RESULT:In total,11 of 99 patients(11.1%)who underwent radical cystectomy were diagnosed with postoperative urethral recurrence. Prostatic stromal involvements prostatic urethral involvement, tumor multifocalityand type of urinary diversion have an important impact on urethral recurrence after radical cystectomy.Regular urethra follow-up doesn’t have a statistically significant effect on improving the patient’s survival rate in our study. (p=0.069)CONCLUSIONS:Only some of the patients experience urethral recurrence following radical cystectomy.Supplementation of cystectomy with simultaneous urethrectomy may not be justified if it is bladder tumor single shot, low grade or negative urethral margin, negative prostatic urethra, negative prostatic stroma. Symptomatic presentation with urethral recurrenceis always associated with advance stage of urethral tumor and has high riskof death from urethral recurrence. Although we didn’l statistically get a positive result on improving the patient’s survival rate, but it can help to detect the urethral recurrence while neoplasms are still in situ would allow for early management with prevention of disease progression or at least prolongation of the disease-free interval.So until larger, prospective, preferably multi-institutional evaluations are performed in patients routinely followed and notfollowed with urethral wash cytology we continue to advocateclose surveillance with routine urethral followup. |
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