URETHRAL RECURRENCE OF TRANSITIONAL-CELL CARCINOMA OF THE BLADDER - PREDICTIVE VALUE OF PREOPERATIVE LATERO-MONTANAL BIOPSIES AND URETHRAL FROZEN-SECTIONS DURING PROSTATOCYSTECTOMY

Objective: The management of the male urethra after cystectomy for bla dder cancer continues to be a dilemma. Patients who undergo a cystecto my require either urinary diversion or bladder substitution. Therefore , the use of the urethra to ensure voiding is important. On the other hand, the probable risk of urethral carcinoma recurrence is generally estimated at approximately 10%. The aim of this study was to assess th e predictive value of preoperative urethral biopsies, and of frozen se ctions during cystoprostatectomy, in patients with invasive bladder ca ncer, Methods: From 1982 to 1986, 118 male patients underwent a cystop rostatectomy for transitional cell carcinoma of the bladder. All patie nts underwent endoscopic latero-montanal biopsies 2 weeks preoperative ly and urethral frozen cut section during radical prostatocystectomy. Results: Carcinoma was observed in 12 patients on both examinations. A ll patients underwent en bloc urethrectomy during cystectomy. In the r emaining 106 patients, the frozen cut margin was negative (including 9 with positive latero-montanal biopsies), and these patients had the u rethra preserved. After a 10-year minimum follow-up, no recurrence was observed in these patients with negative frozen cut section. No signi ficant risk factors fbr urethral recurrence were found. Latero-montana l biopsies did not reveal a positive specificity, and this procedure w as later abandoned in our institution (in 1986). Conclusions: The uret hral frozen section was the only guideline used for simultaneously per forming the urethrectomy, All male patients with negative frozen cut s ections should be considered candidates for bladder substitution. A pr ophylactic urethrectomy is only indicated in patients with carcinoma ( minimum carcinoma in situ) in the frozen urethral margin section durin g cystectomy.