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Positive Pre-cystectomy Biopsies of the Prostatic Urethra or Bladder Neck Do Not Necessarily Preclude Orthotopic Bladder Substitution

2019; Lippincott Williams & Wilkins; Volume: 201; Issue: 5 Linguagem: Inglês

10.1097/ju.0000000000000034

1527-3792

Beat Roth, Marc A. Furrer, Ioannis Giannakis, Mihai Dorin Vartolomei, Silvan Boxler, Patrick Y. Wuethrich, Fiona C. Burkhard, George N. Thalmann, Bernhard Kiss,

Urological Disorders and Treatments

No AccessJournal of UrologyAdult Urology1 May 2019Positive Pre-cystectomy Biopsies of the Prostatic Urethra or Bladder Neck Do Not Necessarily Preclude Orthotopic Bladder SubstitutionThis article is commented on by the following:Editorial CommentEditorial Comment Beat Roth, Marc Alain Furrer, Ioannis Giannakis, Mihai Dorin Vartolomei, Silvan Boxler, Patrick Y. Wuethrich, Fiona C. Burkhard, George N. Thalmann, and Bernhard Kiss Beat RothBeat Roth Department of Urology, University Hospital of Bern, University of Bern, Bern, Switzerland , Marc Alain FurrerMarc Alain Furrer Department of Urology, University Hospital of Bern, University of Bern, Bern, Switzerland , Ioannis GiannakisIoannis Giannakis Department of Urology, University Hospital of Bern, University of Bern, Bern, Switzerland , Mihai Dorin VartolomeiMihai Dorin Vartolomei Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania , Silvan BoxlerSilvan Boxler Department of Urology, University Hospital of Bern, University of Bern, Bern, Switzerland , Patrick Y. WuethrichPatrick Y. Wuethrich Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland , Fiona C. BurkhardFiona C. Burkhard Department of Urology, University Hospital of Bern, University of Bern, Bern, Switzerland , George N. ThalmannGeorge N. Thalmann Department of Urology, University Hospital of Bern, University of Bern, Bern, Switzerland , and Bernhard KissBernhard Kiss †Correspondence: Department of Urology, University Hospital of Bern, University of Bern, CH-3010Bern, Switzerland (telephone: +41 31 632 36 21; FAX: +41 31 632 21 81; e-mail: E-mail Address: [email protected]). Department of Urology, University Hospital of Bern, University of Bern, Bern, Switzerland View All Author Informationhttps://doi.org/10.1097/JU.0000000000000034AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We investigated the influence of positive pre-cystectomy biopsies of the prostatic urethra in males and the bladder neck in females on urethral recurrence, cancer specific and overall survival, and functional outcomes after orthotopic bladder substitution. Materials and Methods: We retrospectively analyzed the records of 803 consecutive patients, including 703 males and 100 females, who underwent orthotopic bladder substitution as well as pre-cystectomy biopsy of the prostatic urethra in males and the bladder neck in females, at our institution between April 1986 and December 2017. Results: Pre-cystectomy biopsies were negative in 755 of the 803 patients (94%) (group 1) and positive in 48 (6%) (group 2). Biopsies in group 2 revealed carcinoma in situ in 35 of the 48 cases (73%), pTaG1/G2 in 5 (10%) and pTaG3/pT1G3 in 8 (17%). Median followup was 64 months (IQR 21–128). At a median followup of 56 months (IQR 18–127) urethral recurrence developed in 45 of the 803 patients (5.6%), including 30 of the 755 (4%) in group 1 and 15 of the 48 (31.3%) in group 2 (p <0.001). Only 10 of the 45 patients (22%) with urethral recurrence required salvage urethrectomy while locally conservative treatment was successful in 27 (60%). Of the remaining 8 patients 6 of 45 (13%) underwent synchronous palliative chemotherapy and 2 of 45 (4%) refused treatment. Multivariate regression analysis revealed a higher risk of urethral recurrence if patients had positive pre-cystectomy biopsies (group 2 HR 6.49, 95% CI 3.33–12.62, p <0.001) or received neoadjuvant or adjuvant chemotherapy (HR 3.05, 95% CI 1.66–5.59, p <0.001). Cancer specific and overall survival as well as functional outcomes were similar in the 2 groups. Conclusions: Positive pre-cystectomy biopsies prior to orthotopic bladder substitution increased the urethral recurrence rate but did not lower cancer specific or overall survival. Most urethral recurrences were managed successfully by local treatment. Orthotopic bladder substitution is an option in highly selected patients with positive, noninvasive pre-cystectomy biopsies, provided that they undergo regular followup including urethral cytology. References 1. : Urinary diversion: how experts divert. 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Google Scholar The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byFurrer M, Kiss B, Studer U, Wuethrich P, Gahl B, Seiler R, Roth B, Bosshard P, Thomas B, Burkhard F, Boxler S and Thalmann G (2021) Seminal Vesical Sparing Cystectomy for Bladder Cancer is Feasible with Good Functional Results without Impairing Oncological Outcomes: A Longitudinal Long-Term Propensity-Matched Single Center StudyJournal of Urology, VOL. 205, NO. 6, (1629-1640), Online publication date: 1-Jun-2021.Smith J (2019) This Month in Adult UrologyJournal of Urology, VOL. 201, NO. 5, (829-830), Online publication date: 1-May-2019.Related articlesJournal of Urology8 Apr 2019Editorial CommentJournal of Urology8 Apr 2019Editorial Comment Volume 201Issue 5May 2019Page: 909-915Supplementary Materials Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.Keywordsprostateurethraurinary bladder neoplasmscystectomybiopsyMetricsAuthor Information Beat Roth Department of Urology, University Hospital of Bern, University of Bern, Bern, Switzerland Equal study contribution. More articles by this author Marc Alain Furrer Department of Urology, University Hospital of Bern, University of Bern, Bern, Switzerland Equal study contribution. More articles by this author Ioannis Giannakis Department of Urology, University Hospital of Bern, University of Bern, Bern, Switzerland More articles by this author Mihai Dorin Vartolomei Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania More articles by this author Silvan Boxler Department of Urology, University Hospital of Bern, University of Bern, Bern, Switzerland More articles by this author Patrick Y. Wuethrich Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland More articles by this author Fiona C. Burkhard Department of Urology, University Hospital of Bern, University of Bern, Bern, Switzerland More articles by this author George N. Thalmann Department of Urology, University Hospital of Bern, University of Bern, Bern, Switzerland More articles by this author Bernhard Kiss Department of Urology, University Hospital of Bern, University of Bern, Bern, Switzerland †Correspondence: Department of Urology, University Hospital of Bern, University of Bern, CH-3010Bern, Switzerland (telephone: +41 31 632 36 21; FAX: +41 31 632 21 81; e-mail: E-mail Address: [email protected]). More articles by this author Expand All The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. 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