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Urethral Cancer Associated With Invasive Bladder Cancer

    Approximately 10% (range, 4%–17%) of patients who undergo cystectomy for bladder cancer can be expected to have or to later develop clinical neoplasm of the urethra distal to the urogenital diaphragm. Factors associated with the risk of urethral recurrence after cystectomy include:[1,2]

    • Tumor multiplicity.
    • Papillary pattern.
    • Carcinomain situ.
    • Tumor location at the bladder neck.
    • Prostatic urethral mucosal or stromal involvement.

    The benefits of urethrectomy at the time of cystectomy need to be weighed against the morbidity factors, which include added operating time, hemorrhage, and the potential for perineal hernia. Tumors found incidentally on pathologic examination are much more likely to be superficial or in situ in contrast to those that present with clinical symptoms at a later date when the likelihood of invasion within the corporal bodies is high. The former lesions are often curable, and the latter are only rarely so. Indications for urethrectomy in continuity with cystoprostatectomy are:

    Recommended Related to Bladder Cancer

    Understanding Bladder Cancer -- Diagnosis and Treatment

    To diagnose bladder cancer, your doctor completes a thorough medical history and examination. You will then be referred to a urologist, a physician who has special training in managing diseases of the bladder. The first test the urologist may perform is an intravenous pyelogram (IVP), followed by a cystoscopy. During a cystoscopy, the urologist will pass a cystoscope (a fiber-optic lighted tube) through the urethra in order to view the bladder. A urine sample for cytology will be obtained and a...

    Read the Understanding Bladder Cancer -- Diagnosis and Treatment article > >

    • Visible tumor in the urethra.
    • Positive swab cytology of the urethra.
    • Positive margins of the membranous urethra on frozen section taken at the time of cystoprostatectomy.
    • Multiple in situ bladder tumors that extend onto the bladder neck and proximal prostatic urethra.

    If the urethra is not removed at the time of cystectomy, follow-up includes periodic cytologic evaluation of saline urethral washings.[2]

    Standard treatment options:

    1. In continuity cystourethrectomy.
    2. Monitor urethral cytology and delayed urethrectomy, if necessary.

    The level of evidence for these treatment options is 3iiiDiv.

    Current Clinical Trials

    Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with urethral cancer associated with invasive bladder cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

    General information about clinical trials is also available from the NCI Web site.

    References:

    1. Trabulsi DJ, Gomella LG: Cancer of the urethra and penis. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 1272-79.
    2. Sherwood JB, Sagalowsky AI: The diagnosis and treatment of urethral recurrence after radical cystectomy. Urol Oncol 24 (4): 356-61, 2006 Jul-Aug.

      WebMD Public Information from the National Cancer Institute

      Last Updated: February 25, 2014
      This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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