[Urethral tumor recurrence following radical cystoprostatectomy--an indication for primary cystoprostato-urethrectomy?].

A total of 273 male patients underwent radical cystoprostatectomy between 1967 and 1987, 22 of them being regarded as at risk for urethral tumor recurrence. In these 22 primary simultaneous urethrectomy was performed or urethrectomy followed shortly after cystectomy because of the histology of the cystectomy specimen. Of the remaining 251 patients, a urethral tumor recurrence was observed in 23 (9.2%). Another patient with a urethral recurrence had originally been operated on in another hospital. The first urethral tumor recurrence was observed in 1977, but between October 1987 and May 1988, 7 patients were treated for urethral recurrence or rerecurrence, suggesting that this problem will be recorded increasingly often with improved survival rates from the original bladder tumor and longer follow-up of these patients. In 21 of the 24 patients with recurrence, multifocal tumor growth (multiple primary tumors, multifocal carcinoma in situ, unifocal primary tumor with concomitant carcinoma in situ or severe dysplasia) was found in their primary cystectomy specimen. Two had unifocal tumors. The original histology of the patient operated on elsewhere is not known. The data suggest that primary simultaneous urethrectomy should be performed in all patients undergoing cystoprostatectomy for multifocal bladder tumors. All patients in whom the urethra is left in place need regular washout cytologies of the urethra for the rest of their lives to ensure early diagnosis of any urethral tumor recurrences.