A Clinical Study On Urethral Recurrence Observed After Cystectomy

Abstract

A clinical study was made on 108 male patients who underwent cystectomy. The posterior urethra and partial anterior urethra were removed in 47 cases, half of the pendicular urethra was removed in 13 cases and the anterior urethra up to the fossa navicularis was removed in 48 cases. Out of 60 cases without urethrectomy, urethral recurrence was observed in 13 cases (21.7%), while no recurrence was observed in the cases treated with urethrectomy. The average period of time from cystectomy to urethral recurrence was 24.7 months (11~39 months). Urethral cancer of such early stages as pIa and pIb were found in 3 and 6 cases, respectively. Stage pT2 was found in 4 cases. Grade 1 cancer was found in 3 cases, grade 2, in 5 cases, and 3 in 5 cases. The proximal end of the pendicular urethra was found to be the most frequent site for recurrence with 11 cases exhibiting recurrence at this location and 2 cases at the mid-portion of the pendicular urethra. Many cases exhibited multiple recurrence of tumor of visually grayish, velvety and non-papillary type which was histologically all transitional cell carcinoma. Bladder tumor with higher grade tendend to cause urethral cancer recurrence with higher grade. Bladder tumors at multiple locations from the trigone to the lateral and posterior walls tended to cause recurrence in the urethra (p<0.05). Of all the cases, 10 cases underwent urethrectomy and 2 cases penectomy. 12 cases received chemotherapy and 5 cases radiation therapy as postoperative adjuvant treatments. For cases without any surgical treatment, anti-cancer drugs adherent to mucous membrane were instilled into the urethra. Consequently, all the 5 patients who were unable to undergo a total urethrectomy due to urethral recurrence died of cancer. The mortality rate for the cases with urethral recurrence was 38.5% (5 out of 13 cases), which is higher than that of 2.1% (one in 47 cases) for those which underwent cystectomy without causing recurrence. © 1990, THE JAPANESE UROLOGICAL ASSOCIATION. All rights reserved.