TRANSITIONAL CELL CARCINOMA OF URETHRA AFTER TREATMENT OF URINARY BLADDER CANCER

In order to further understand the pattern of activities of urethral tumor reappearance after cystectomy for cancer of the bladder, 900 patients with the condition and 10 cases undergoing cystourethrectomy were evaluated. Of 184 male patients having total cystectomy, 18(10%) subsequently developed urethral tumors, whereas of 570 patients undergoing partial cystectomy only 6 (1%) developed this kind of tumor. Of additional 10 patients on whom en bloc cystourethrectomy was performed for concomitant presence of carcinoma in situ and suspected urethral abnormality, 2 were carcinoma in situ, 1 papillary transitional cell carcinoma, and 3 marked epithelial atypia of the urethra. Histopathologically, of the 24 bladder specimens, 15 were G2, 9 G3, 14 T1-T2, and 10 T3-T4 according to their grading and staging. Of the 24 urethras removed, 8 had cancer at the urethral stub, 5 had multiple lesions over the entire urethra, and 11 with lesions at the anterior urethra, of which most had no tumor cells microscopically at the excised margin. These indicate that tumor recurrence in the retained urethra following cystectomy could be a reflection of tumor multicentricity, particularly correlative to the histology and locality of the primary vesical tumor. En bloc cystourethrectomy is only justified when the extent of the bladder lesion and its urethral involvement are evident.