INDICATIONS FOR LOWER URINARY-TRACT RECONSTRUCTION IN WOMEN AFTER CYSTECTOMY FOR BLADDER-CANCER - A PATHOLOGICAL REVIEW OF FEMALE CYSTECTOMY SPECIMENS

Purpose: In an attempt to identify women who may be appropriate candid ates for orthotopic lower urinary tract reconstruction, archival cyste ctomy specimens from female patients undergoing cystectomy for primary bladder cancer were reviewed. These pathological findings should prov ide a better understanding of tumor involvement at the bladder neck (v esicourethral junction) and urethra in women with transitional cell ca rcinoma of the bladder. Materials and Methods: Cystectomy specimens of 67 consecutive women undergoing surgery for biopsy proved transitiona l cell carcinoma of the bladder between July 1982 and July 1990 were p athologically reviewed. Results: Histological evidence of tumor (carci noma in situ or gross carcinoma) involving the urethra was present in 9 patients (13%). Tumor was confined to the proximal and mid urethra, and the distal urethra was not involved. All patients with carcinoma i nvolving the urethra had concomitant evidence of carcinoma involving t he bladder neck. A total of 17 patients (25%) had tumor involvement of the bladder neck and those with an uninvolved bladder neck also had a n uninvolved urethra. The association between the presence of tumor in the bladder neck and urethra was highly significant (p less than or e qual to 0.00012). Tumor involving the bladder neck and urethra tended to be more commonly associated with high grade and stage tumors, and n ode-positive disease. Conclusions: Although the fate of the retained u rethra following cystectomy for bladder cancer in women is unknown, th ese results show that women with transitional cell carcinoma of the bl adder without evidence of tumor involving the bladder neck are at low risk for urethral malignancy. These patients may be offered lower urin ary tract reconstruction that includes preservation of and diversion t hrough the urethra (orthotopic diversion). Urethral surveillance will be necessary, as it is in men after orthotopic urinary diversion.