550 692
[10]
.
It is important to identify patients at highest risk of
urethral malignant disease. A number of studies have tried
to address this issue in recent years. In these series,
prostatic urethral
[10,12]and stromal
[14]involvement,
tumor multifocality
[10], pathological T-stage
[15], espe-
cially nonmuscle invasive tumor stage (Ta, Tis, T1)
[11],
performance of nonorthotopic diversions
[10] ,and a
positive final urethral margin at RC
[14]have been
independently associated with secondary urethral carcino-
ma. In this regard, the rate of secondary urethral tumors in
men with stage T4a disease treated with RC and orthotopic
bladder substitution (OBS) was found to be only 6%. This
occured after a median of approximately 2 yr after RC and
suggests the prognostic value of nonorgan confined disease
at the time of RC
[16,17]. For women, bladder neck
involvement has been shown to be a strong predictor for
the presence of concomitant urethral as well as secondary
urethral tumors
[18].
Interestingly, large studies have reported that patients
with OBS are at a significantly lower risk for secondary
urethral malignancy compared to those with nonorthotopic
diversions
[10,15]. Of the 224 patients with urethral
recurrence
( Table 1), 71 (31.7%) were found in patients
with orthotopic bladder substitutes compared with
[(Fig._1)TD$FIG]
UTUC =
upper tract urothelial carcinoma.
PubMed online search results:
“radical cystectomy + remnant + urothelium”
n
= 21
“radicalcystectomy + upper tract recurrence”
n
=116
“radical cystectomy + urethral recurrence”
= 234
n
“radical cystectomy + UTUC”
n
= 138
“radical cystectomy + urethral carcinoma”
n
= 337
“radical cystectomy + urothelium”
= 223
n
Initially assessed publications through title
and hand search
(
n
=1069)
Finally included studies
(
n
=57)
Exclusion of: 776
-Unrelated articles
(
n
= 647)
- Articles not written in English
(
n
=92)
- Case reports
(
n
= 28)
- Editorial comment
(
n
= 9)
Exclusion of: 185
- Unrelated articles
(
n
= 49)
- Review articles
(
n
= 18)
- Repeated publications
(
n
= 115)
- Case reports
(
n
= 2)
- No abstract available
(
n
= 1)
Exclusion of: 51
- Unrelated articles or not (specifically
addressing the topic)
Full-text relevance assessment
(
n
=108)
Initially assessed publications through
abstractor hand search
(
n
=293)
Fig. 1 – This Consolidated Standards of Reporting Trials diagram outlines the selection process of the included studies.
UTUC = upper tract urothelial carcinoma.
E U R O P E A N U R O L O G Y 7 1 ( 2 0 1 7 ) 5 4 5 – 5 5 7
550