Positive Precystectomy Biopsies of the Prostatic Urethra or Bladder Neck Do Not Necessarily Preclude Orthotopic Bladder Substitution.

Roth, Beat; Furrer, Marc; Giannakis, Ioannis; Vartolomei, Mihai Dorin; Boxler, Silvan; Wüthrich, Patrick Yves; Burkhard, Fiona; Thalmann, George; Kiss, Bernhard (2019). Positive Precystectomy Biopsies of the Prostatic Urethra or Bladder Neck Do Not Necessarily Preclude Orthotopic Bladder Substitution. The journal of urology, 201(5), pp. 909-915. American Urological Association 10.1097/JU.0000000000000034

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PURPOSE We investigated the influence of positive precystectomy 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 precystectomy biopsy of the prostatic urethra in males and the bladder neck in females, at our institution between April 1986 and December 2017. RESULTS Precystectomy 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 precystectomy 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 precystectomy 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 precystectomy biopsies, provided that they undergo regular followup including urethral cytology.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Urology
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Roth, Beat; Furrer, Marc; Boxler, Silvan; Wüthrich, Patrick Yves; Burkhard, Fiona; Thalmann, George and Kiss, Bernhard

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1527-3792

Publisher:

American Urological Association

Language:

English

Submitter:

Jeannine Wiemann

Date Deposited:

27 Jun 2019 11:44

Last Modified:

23 Oct 2019 06:29

Publisher DOI:

10.1097/JU.0000000000000034

PubMed ID:

30694935

Uncontrolled Keywords:

biopsy cystectomy prostate urethra urinary bladder neoplasms

BORIS DOI:

10.7892/boris.128102

URI:

https://boris.unibe.ch/id/eprint/128102

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