PROSPECTIVE PATHOLOGICAL ANALYSIS OF FEMALE CYSTECTOMY SPECIMENS - RISK-FACTORS FOR ORTHOTOPIC DIVERSION IN WOMEN

Objectives. To prospectively evaluate our previously established patho logic risk factors in women undergoing cystectomy for bladder cancer a nd to determine if these criteria identify appropriate female candidat es for orthotopic diversion. Methods. Prospective pathologic evaluatio n was performed on 71 consecutive female cystectomy specimens removed for primary transitional cell carcinoma of the bladder. The histologic grade, pathologic stage, presence of carcinoma in situ, number, and l ocation of tumors were determined. In addition, final pathologic analy sis of the bladder neck and proximal urethra was performed and compare d with the intraoperative frozen-section analysis of the distal margin (proximal urethra). Results. Tumor at the bladder neck and proximal u rethra was seen in 14 (19%) and 5 (7%) cystectomy specimens, respectiv ely. Bladder neck tumor involvement was found to be the most significa nt risk factor for tumor involving the urethra (P < 0.001). All patien ts with urethral tumors demonstrated concomitant bladder neck tumors. However, more than 60% of patients with bladder neck tumors had a norm al (tumor-free) proximal urethra. Furthermore, no patient with a norma l bladder neck demonstrated tumor involvement of the urethra. Intraope rative frozen-section analysis of the distal surgical margin was perfo rmed on 47 patients: 45 without evidence of tumor and 2 patients with urethral tumor involvement. In all cases, the intraoperative frozen-se ction analysis was correctly confirmed by final permanent section. Con clusions. We prospectively demonstrate that bladder neck tumor involve ment is a significant risk factor for urethral tumor involvement in wo men. However, despite bladder neck tumor involvement, a number of wome n undergoing cystectomy for bladder cancer have a normal urethra and m ay be candidates for orthotopic diversion. Furthermore, our data demon strate that intraoperative frozen-section analysis of the distal surgi cal margin accurately and reliably evaluates the proximal urethra and currently determines which patients undergo orthotopic diversion at ou r institution. (C) 1998, Elsevier Science Inc. All rights reserved.