# Safety of urethral preservation using urethral frozen section analysis in radical cystectomy

## TL;DR

This study shows that using frozen section analysis during surgery can safely determine if the urethra can be preserved after bladder removal for cancer.

## Contribution

The study introduces urethral frozen section analysis as a safe method to guide urethra preservation during radical cystectomy.

## Key findings

- Urethral frozen section analysis had a 100% negative predictive value for cancer recurrence.
- No urethral recurrence was observed in patients who preserved their urethra after surgery.
- FSA helped safely decide whether to remove or preserve the urethra during radical cystectomy.

## Abstract

The objective of this study is to assess whether urethral preservation can be performed safely using frozen section analysis (FSA) of the urethral stump on urethral recurrence after radical cystectomy.

Between June 2012 and July 2022, we investigated consecutive male patients who underwent urethral FSA during radical cystectomy for urothelial carcinoma. For FSA‐abnormal cases, urethrectomy was performed, and for FSA‐normal cases, the urethra was preserved. The diagnostic accuracy of FSA was assessed in comparison with the pathological findings of the permanent sections of the same tissue. Postoperatively, computed tomography and urinary cytology were performed as routine surveillance of recurrence.

Of the 77 patients included in this study, three patients with abnormal FSA underwent concurrent urethrectomy. The negative predictive value of urethral FSA was 100%. With a median postoperative follow‐up of 38 months (interquartile ranges 21–71), no urethral recurrence was observed.

FSA may be useful in determining the indication for urethrectomy.