EURURO Vol. 71 No. 4

555 692

in higher accuracy rates A recent report by Yafi et al
investigated patterns of recurrence among
1890 patients treated with RC for bladder cancer. Annual
urinary cytology was recommended as optional in all
cystectomized patients irrespective of stage every 12 mo
postoperatively until completion of the 5th postoperative
year. In our opinion, as voided urinary cytology (or urethral
washings) is a simple, cheap, and easily performable
diagnostic procedure, it should be conducted at least
annually in patients with risk factors for pan-urothelial
disease for the 1st 5 yr after RC. In case of positive findings a
diagnostic urethroscopy and cross-sectional imaging of the
upper tract should be performed along with biopsy
[82_TD$DIFF]assessment of the urethra and upper tract in case of
suspicious findings.
In addition, combined cytological evaluation and quan-
titative digital cytometry has shown to improve the
detection of malignant cells in urine samples after diversion
. Yet, it has to be stated that the exact frequency and
duration of surveillance of the remnant urothelium after RC
remain to be determined. Admittedly, prospective trials are
needed to demonstrate whether an intense surveillance
regimen is prognostically superior to a less-intense or
symptom-oriented strategy for patients who show several
histological features of panurothelial disease at RC.
4. Conclusions
Secondary urothelial tumors occur in approximately 4–10%
of patients following RC and are often associated with
adverse prognosis, in part due to delayed diagnosis. Indeed,
nephrouretectomy and urethrectomy can be curative in
noninvasive and early invasive disease stages. There is a
need for early diagnosis and treatment of urethral
recurrences as they are often detected at late stages with
worse outcomes. As such, follow-up based on a risk-adapted
strategy should be adopted for patients with histological
features of panurothelial disease to facilitate early detection
in those at high risk of recurrence and avoid overtesting
patients at low risk for subsequent metachronous urothelial
tumor development.
Author contributions: Georgios Gakis had full access to all the data in the
study and takes responsibility for the integrity of the data and the accuracy
of the data analysis.
Study concept and design: Gakis, Kassouf.
Acquisition of data: Gakis.
Analysis and interpretation of data: Gakis, Black, Bochner, Stenzl,
Thalmann, Kassouf.
Drafting of the manuscript: Gakis.
Critical revision of the manuscript for important intellectual content: Gakis,
Black, Bochner, Stenzl, Thalmann, Kassouf.
Statistical analysis: Gakis.
Obtaining funding: None.
Administrative, technical, or material support: None.
Supervision: Kassouf.
Other: None.
Financial disclosures: Georgios Gakis certifies that all conflicts of
interest, including specific financial interests and relationships and
affiliations relevant to the subject matter or materials discussed in the
manuscript (eg, employment/affiliation, grants or funding, consultan-
cies, honoraria, stock ownership or options, expert testimony, royalties,
or patents filed, received, or pending), are the following: None.
Funding/Support and role of the sponsor: None.
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