URETHRAL RECURRENCE IN PATIENTS WITH ORTHOTOPIC ILEAL NEOBLADDERS

Purpose: We identified the risk of urethral recurrence following cyste ctomy for transitional cell bladder carcinoma, stratified by pathologi cal characteristics of the bladder tumor and type of urinary diversion . Materials and Methods: The pathological characteristics and clinical courses of 174 men with a Kock ileal neobladder and 262 with a cutane ous urinary diversion were analyzed for time to urethral recurrence. R esults: Urethral recurrence was identified in 34 patients at a median of 1.6 years after cystectomy, for an overall 7.9% 5-year risk of recu rrence. Carcinoma in situ (p = 0.71) and multifocality (p = 0.17) did not independently confer an increased risk of recurrence. Prostatic ur ethral involvement, particularly stromal invasion, significantly incre ased the probability of recurrence (p < 0.001). Patients with a Kock i leal neobladder had a significantly lower probability of recurrence co mpared to those with cutaneous diversion (p = 0.015), even when associ ated with prostatic urethral involvement. Conclusions: Patients with a Kock ileal neobladder have a lower risk of urethral recurrence than t hose with cutaneous urinary diversion, even when associated with a hig h risk pathological condition predicting increased risk of urethral re currence.