Anterior urethra sparing cystoprostatectomy for bladder cancer: a 10-year, single center experience

TL;DR

This study shows that sparing the anterior urethra during bladder cancer surgery is oncologically safe for carefully selected patients.

Contribution

Long-term data supporting the safety of anterior urethra sparing cystoprostatectomy in bladder cancer patients.

Findings

Low recurrence rate (2.0%) in the remnant anterior urethra over long-term follow-up.

Age at surgery and lymph node status were independent prognostic factors for survival outcomes.

Similar recurrence-free and disease-specific survival rates between ileal conduit and neobladder groups.

Abstract

Decision making regarding the urethra before and after radical cystectomy due to urothelial carcinoma has always been controversial. To determine whether anterior urethra sparing cystoprostatectomy for bladder cancer is an oncologically-safe procedure, we evaluated the long-term oncologic clinical outcome.

A total of 51 male patients with cTa-4N0-2M0 bladder cancer were treated with anterior urethra sparing cystoprostatectomy and simultaneous urinary diversion between 2000 and 2013, and underwent follow up for 4 months or more. We assessed differences in the perioperative outcomes, oncologic outcomes and recurrence rates according to the urinary diversion.

The median patient age and follow-up period were 66 years and 35 months, respectively. The 5- and 10-year recurrence free survival (RFS) rates in ileal conduit (IC) group vs. orthotopic neobladder reconstruction (NB) group were 45.0 and 20.3% vs. 39.3 and 19.6%, respectively. Likewise, the 5- and 10-year disease specific survival (DSS) were 52.7 and 32.1% vs. 39.3 and 29.5%, respectively. Multivariate analysis revealed two independent prognostic factors for RFS and DSS, including age at surgery and lymph node status. Local recurrence in the remnant anterior urethra occurred in only 1 patient (2.0%) at 57 months after surgery.

Our long-term data show that anterior urethra sparing cystoprostatectomy is an oncologically-safe procedure regardless of the type of urinary diversion in a subset of carefully selected patients with bladder cancer without evidence of urothelial carcinoma in the urethra/bladder neck and urethral surgical margin.

The online version of this article (doi:10.1186/s40064-015-1200-7) contains supplementary material, which is available to authorized users.

Figures