Roberto Carando1,2,3,4, Shahrokh F Shariat5,6,7,8,9,10, Marco Moschini4, David D'Andrea5. 1. Clinica Luganese Moncucco, Lugano. 2. Clinica S. Anna, Swiss Medical Group, Sorengo. 3. Clinica Santa Chiara, Locarno. 4. Department of Urology, Luzerner Kantonsspital, Spitalstrasse, Luzern, Switzerland. 5. Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria. 6. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia. 7. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. 8. Department of Urology, Weill Cornell Medical College, New York, New York. 9. Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. 10. Department of Urology, Motol Hospital, 2nd faculty of medicine, Charles University, Prague, Czech Republic.
Abstract
PURPOSE OF REVIEW: The clinical significance of ureteral and urethral recurrence in patients treated with radical cystectomy for bladder cancer is scarce and heterogeneous. The aim of the current review is to summarize the recent literature on incidence, diagnosis and oncologic outcomes of ureteral and urethral recurrences after radical cystectomy. RECENT FINDINGS: Frozen section analysis (FSA) of ureteral margin had a sensitivity and specificity of 69-77 and 83-96%, respectively. Considering the ureteral margin, the reported sensitivity and specificity were 33-93 and 99-100%, respectively. Transurethral biopsy of the prostatic urethra might help in counseling patients' treatment, although its accuracy and prognostic role is highly questionable. In patients treated with radical cystectomy, recurrence of the urethra or ureteral are rare, occurring approximately in 5% of patients. During the follow-up, urinary cytology and cross-sectional imaging improve the early detection of recurrence in asymptomatic patients, although the majority are diagnosed for symptomatic presentation. Their use should be tailored to the patient's risk of ureteral and/or urethral recurrence. Urethrectomy is indicated in case of singular urethral recurrence, whereas no clear data exists regarding the best management of ureteral recurrence, except surgical removal. SUMMARY: Intraoperative FSA of ureters and urethra share good specificity but poor sensitivity. Recurrence at urethra and upper tract are rare and discordant data exists regarding survival outcomes. Oncologic surveillance after radical cystectomy with the aim to detect these recurrences should be tailored to the individualized patient's risk.
PURPOSE OF REVIEW: The clinical significance of ureteral and urethral recurrence in patients treated with radical cystectomy for bladder cancer is scarce and heterogeneous. The aim of the current review is to summarize the recent literature on incidence, diagnosis and oncologic outcomes of ureteral and urethral recurrences after radical cystectomy. RECENT FINDINGS: Frozen section analysis (FSA) of ureteral margin had a sensitivity and specificity of 69-77 and 83-96%, respectively. Considering the ureteral margin, the reported sensitivity and specificity were 33-93 and 99-100%, respectively. Transurethral biopsy of the prostatic urethra might help in counseling patients' treatment, although its accuracy and prognostic role is highly questionable. In patients treated with radical cystectomy, recurrence of the urethra or ureteral are rare, occurring approximately in 5% of patients. During the follow-up, urinary cytology and cross-sectional imaging improve the early detection of recurrence in asymptomatic patients, although the majority are diagnosed for symptomatic presentation. Their use should be tailored to the patient's risk of ureteral and/or urethral recurrence. Urethrectomy is indicated in case of singular urethral recurrence, whereas no clear data exists regarding the best management of ureteral recurrence, except surgical removal. SUMMARY: Intraoperative FSA of ureters and urethra share good specificity but poor sensitivity. Recurrence at urethra and upper tract are rare and discordant data exists regarding survival outcomes. Oncologic surveillance after radical cystectomy with the aim to detect these recurrences should be tailored to the individualized patient's risk.
Authors: Francesco Claps; Maaike W van de Kamp; Roman Mayr; Peter J Bostrom; Joost L Boormans; Markus Eckstein; Laura S Mertens; Egbert R Boevé; Yann Neuzillet; Maximilian Burger; Damien Pouessel; Carlo Trombetta; Bernd Wullich; Theo H van der Kwast; Arndt Hartmann; Yves Allory; Yair Lotan; Shahrokh F Shariat; Tahlita C M Zuiverloon; M Carmen Mir; Bas W G van Rhijn Journal: World J Urol Date: 2021-07-01 Impact factor: 4.226