Follow-up of the Urethra and Management of Urethral Recurrence After Radical Cystectomy: A Systematic Review and Proposal of Management Algorithm by the European Association of Urology—Young Academic Urologists: Urothelial Carcinoma Working Group
Year: 2022
Type: review
Abstract: CONTEXT: Surveillance of the urethra and management of urethral recurrence (UR) after radical cystectomy (RC) is an area with poor evidence. OBJECTIVE: We aimed to summarize the available evidence and provide clinicians with practical recommendations on how to prevent and manage UR after RC for bladder cancer. EVIDENCE ACQUISITION: The MEDLINE and EMBASE databases were searched during September 2021 for studies evaluating UR after RC. The primary endpoint was oncologic outcomes for patients who experienced UR depending on different surveillance and management approaches. EVIDENCE SYNTHESIS: Forty-three studies were included in the quantitative synthesis. According to the currently available literature, a tight-knitted surveillance protocol should be implemented for males treated with RC and nonorthotopic neobladder diversion as well as patients with prostatic involvement, tumor multifocality, bladder neck involvement, and concomitant carcinoma in situ. A survival benefit of a prophylactic urethrectomy has been reported only in patients at very high risk for UR based on clinical factors. Surveillance protocols were highly heterogeneous and poorly documented among included studies. Patients whose UR was diagnosed based on clinical symptoms had a poor prognosis. Only limited data were available on the comparative effectiveness of watchful waiting after RC versus clinical symptom screening as part of a follow-up strategy. However, the use of regular cytology and/or urethroscopy seems useful in select patients at high risk for UR. Despite limited data on the optimal management of UR, urethra-sparing approaches (transurethral resection of UR) seem to be an option for Ta (only) recurrences; a salvage urethrectomy with or without chemotherapy should be the standard for all others. CONCLUSIONS: Based on the currently available literature, we have proposed an algorithm to guide the decision-making process to help identify and treat UR after RC. Given the lack of evidence on how to deal with UR and surveil patients at risk for UR, this study may invigorate research in this area of unmet need. PATIENT SUMMARY: Early diagnosis and tailored management of urethral recurrence could help improve oncologic outcomes in these patients.
Source: European Urology Focus
Authors: Ekaterina Laukhtina, Marco Moschini, Francesco Soria, David D. Andrea, Jeremy Yuen-Chun Teoh, Keiichiro Mori, Simone Albisinni, Andrea Mari, Wojciech Krajewski, Alessia Cimadamore, Mohammad Abufaraj, Dmitry Enikeev, Yann Neuzillet, Gianluca Giannarini, Evanguelos Xylinas, Ashish M. Kamat, Morgan Roupret, Marko Babjuk, J. Alfred Witjes, Shahrokh F. Shariat, Benjamin Pradere
Institutions: Sechenov University, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vita-Salute San Raffaele University, Azienda Ospedaliero Universitaria San Giovanni Battista, University of Turin, Chinese University of Hong Kong, Jikei University School of Medicine, Université Libre de Bruxelles, Erasmus Hospital, Azienda Ospedaliero-Universitaria Careggi, University of Florence, University of Wrocław, Wroclaw Medical University, Marche Polytechnic University, University of Jordan, Jordan University Hospital, Université de Versailles Saint-Quentin-en-Yvelines, Hôpital Foch, Ospedale Santa Maria della Misericordia di Udine, Assistance Publique – Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard, The University of Texas MD Anderson Cancer Center, Sorbonne Université, Pitié-Salpêtrière Hospital, Onco-Urologie Prédictive, Charles University, Radboud University Nijmegen, Cornell University, Weill Cornell Medicine, The University of Texas Southwestern Medical Center
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,550
OpenAlex ID: W4221102828