Del Giudice Francesco, Gad Mohamed, Santarelli Valerio, Nair Rajesh, Abu-Ghanem Yasmin, Mensah Elsie, Challacombe Ben, Kam Jonathan, Ibrahim Youssef, Lufti Basil, Khan Amir, Yeasmin Akra, Chatterton Kathryn, Amery Suzanne, Spurna Katarina, Alao Romerr, Ali Kirmani Syed Ghazi, Crocetto Felice, Barone Biagio, Rocco Bernardo, Sciarra Alessandro, Chung Benjamin I, Thurairaja Ramesh, Khan Muhammad Shamim
Department of Maternal-Infant and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, 00185 Rome, Italy.
Department of Urology, Stanford University School of Medicine, Stanford, CA 94304, USA.
J Pers Med. 2025 Aug 14;15(8):375. doi: 10.3390/jpm15080375.
The role of urethrectomy at the time of Robotic-Assisted or Open Radical Cystectomy (RARC, ORC) is controversial. Whether urethrectomy should be performed at the time of RARC/ORC or delayed up to a 3-6 month interval is unclear. We performed a retrospective cohort analysis of perioperative and survival outcomes in patients with high-risk NMIBCs or non-metastatic MIBCs at our institution who underwent either concomitant or deferred urethrectomy after RC. cTis-T1 or cT2-T4, N0-1, M0 BC patients who underwent RARC or ORC from 2009 to 2024 were reviewed. Clinical, demographic, tumour, and patient characteristics and perioperative variables were assessed across concomitant and delayed urethrectomy groups. Multivariate logistic analysis was performed to estimate the impact of significant variables on intraoperative and postoperative outcomes. Univariable Kaplan-Meier and multivariable Cox regression modelling was implemented to explore the relative effect of time of urethrectomy on progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). A total of = 58 patients ( = 47 delayed vs. = 11 concomitant) with similar demographic characteristics were included. The concomitant urethrectomy group experienced longer operative time and greater blood loss (379 ± 65 min and 430 ± 101 mL vs. 342 ± 82 min and 422 ± 125 mL, with = 0.049 and = 0.028, respectively). Hospital readmission rates were higher in the concomitant urethrectomy group (36.4% vs. 8.5%, = 0.016; OR: 17.9; 95% CI 1.2-265; = 0.036). In Cox regression analysis, the timing of urethrectomy had no influence on PFS, CSS, or OS (all > 0.05). Our study suggests that urethrectomy can be safely deferred unless urothelial disease is clearly present pre- or intraoperatively without compromising survival outcome and with the advantage of reducing surgical morbidity at the time of RC.
在机器人辅助或开放性根治性膀胱切除术（RARC，ORC）时行尿道切除术的作用存在争议。在RARC/ORC时是否应进行尿道切除术或推迟至3 - 6个月的间隔时间尚不清楚。我们对本院高危非肌层浸润性膀胱癌（NMIBC）或非转移性肌层浸润性膀胱癌（MIBC）患者在根治性膀胱切除术（RC）后进行同期或延期尿道切除术的围手术期和生存结果进行了回顾性队列分析。回顾了2009年至2024年接受RARC或ORC的cTis - T1或cT2 - T4、N0 - 1、M0期膀胱癌患者。对同期和延期尿道切除术组的临床、人口统计学、肿瘤和患者特征以及围手术期变量进行了评估。进行多变量逻辑分析以估计显著变量对术中和术后结果的影响。采用单变量Kaplan - Meier和多变量Cox回归模型来探讨尿道切除术时间对无进展生存期（PFS）、癌症特异性生存期（CSS）和总生存期（OS）的相对影响。共纳入58例（47例延期组与11例同期组）具有相似人口统计学特征的患者。同期尿道切除术组的手术时间更长，失血量更大（分别为379±65分钟和430±101毫升，对比342±82分钟和422±125毫升，P分别为0.049和0.028）。同期尿道切除术组的住院再入院率更高（36.4%对比8.5%，P = 0.016；OR：17.9；95%CI 1.2 - 265；P = 0.036）。在Cox回归分析中，尿道切除术时间对PFS、CSS或OS均无影响（所有P>0.05）。我们的研究表明，除非术前或术中明确存在尿路上皮疾病，否则可以安全地推迟尿道切除术，这不会影响生存结果，并且具有降低RC时手术并发症的优势。
