Urethrectomy at the time of radical cystectomy for non-metastatic urothelial carcinoma of the bladder: a collaborative multicenter study.

The optimal management of the urethra in patients planned for radical cystectomy (RC) remains unclear. We sought to evaluate the impact of urethrectomy on perioperative and oncological outcomes in patients treated with RC for non-metastatic urothelial carcinoma of the bladder (UCB).

We assessed the retrospective data from patients treated with RC for UCB of five European University Hospitals. Associations of urethrectomy with progression-free (PFS), cancer-free (CSS), and overall (OS) survivals were assessed in univariable and multivariable Cox regression models. We performed a subgroup analysis in patients at high risk for urethral recurrence (UR) (urethral invasion and/or bladder neck invasion and/or multifocality and/or prostatic urethra involvement).

A total of 887 non-metastatic UCB patients were included. Among them, 146 patients underwent urethrectomy at the time of RC. Urethrectomy was performed more often in patients with urethral invasion, T3/4 tumor stage, CIS, positive frozen section analysis of the urethra, and those who received neoadjuvant chemotherapy, underwent robotic RC, and/or received an ileal conduit urinary diversion (all p < 0.001). Estimated blood loss and the postoperative complication rate were comparable between patients who received an urethrectomy and those who did not. Urethrectomy during RC was not associated with PFS (HR 0.83, p = 0.17), CSS (HR 0.93, p = 0.67), or OS (HR 1.08, p = 0.58). In the subgroup of 276 patients at high risk for UR, urethrectomy at the time of RC decreased the risk of progression (HR 0.58, p = 0.04).

In our study, urethrectomy at the time of RC seems to benefit only patients at high risk for UR. Adequate risk assessment of UCB patients' history may allow for better clinical decision-making and patient counseling.

World journal of urology. 2022 May 20 [Epub ahead of print]

Ekaterina Laukhtina, Axelle Boehm, Benoit Peyronnet, Carlo Andrea Bravi, Jose Batista Da Costa, Francesco Soria, David D'Andrea, Pawel Rajwa, Fahad Quhal, Takafumi Yanagisawa, Frederik König, Hadi Mostafaei, Dmitry Enikeev, Alexandre Ingels, Gregory Verhoest, Frederiek D'Hondt, Alexandre Mottrie, Steven Joniau, Hendrik Van Poppel, Alexandre de la Taille, Karim Bensalah, Franck Bruyère, Shahrokh F Shariat, Benjamin Pradere

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria., Department of Urology, University Hospital of Tours, Tours, France., Department of Urology, University Hospital of Rennes, Rennes, France., Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy., Department of Urology, University Hospital Henri Mondor, AP-HP, UPEC, AP-HP, 51 Avenue du Maréchal de Lattre de Tassigny, 95010, Créteil Cedex, France., Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, Torino School of Medicine, Turin, Italy., Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia., Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium., Department of Urology, University Hospitals Leuven, Leuven, Belgium., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. .