Indications for Ureterectomy in Men Undergoing Single Stage Radical Cystectomy for Bladder Cancer

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Abstract
During a 10 yr period 174 consecutive male patients underwent radical cystectomy with pelvic lymph node dissection for transitional cell cancer of the bladder. Urethrectomy, either performed en bloc with the cystectomy or secondarily, was required in 23 patients. Of these 23 patients 9 died of metastatic disease and 4 deaths were believed to be directly related to development of tumor in the urethra. Patient selection is possible so that urethrectomy in all patients undergoing cystectomy may be avoided, while maintaining the ability to treat those at risk for carcinoma in the retained urethra before invasion occurs. Indications recommended for urethrectomy are en bloc cystourethrectomy for clinically overt involvement of the anterior urethra with carcinoma or tumor extending into the prostatic urethra, immediate or delayed total urethrectomy either during the initial hospitalization or within 2 mo. of cystectomy for all patients with pathological evidence of invasion of the prostate (P4) or carcinoma in situ of the prostatic urethra, indefinite close followup of all patients whose bladder specimens demonstrate carcinoma in situ (urethral cytology within 4 mo. of cystectomy and every year thereafter, and immediate total urethrectomy for any urethral cytology positive for malignant cells), and immediate total urethrectomy for any patient experiencing bloody urethral discharge.