TY - JOUR
T1 - Follow-up of the Urethra and Management of Urethral Recurrence After Radical Cystectomy
T2 - A Systematic Review and Proposal of Management Algorithm by the European Association of Urology—Young Academic Urologists: Urothelial Carcinoma Working Group
AU - European Association of Urology
AU - Young Academic Urologists EAU-YAU: Urothelial Carcinoma Working Group
AU - the European Association of Urology Section of Oncological Urology ESOU
AU - Laukhtina, Ekaterina
AU - Moschini, Marco
AU - Soria, Francesco
AU - Andrea, David D.
AU - Teoh, Jeremy Yuen Chun
AU - Mori, Keiichiro
AU - Albisinni, Simone
AU - Mari, Andrea
AU - Krajewski, Wojciech
AU - Cimadamore, Alessia
AU - Abufaraj, Mohammad
AU - Enikeev, Dmitry
AU - Neuzillet, Yann
AU - Giannarini, Gianluca
AU - Xylinas, Evanguelos
AU - Kamat, Ashish M.
AU - Roupret, Morgan
AU - Babjuk, Marko
AU - Witjes, J. Alfred
AU - Shariat, Shahrokh F.
AU - Pradere, Benjamin
N1 - Publisher Copyright:
© 2022 The Authors
PY - 2022/11
Y1 - 2022/11
N2 - 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.
AB - 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.
KW - Radical cystectomy
KW - Urethral recurrence
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U2 - 10.1016/j.euf.2022.03.004
DO - 10.1016/j.euf.2022.03.004
M3 - Review article
C2 - 35337773
AN - SCOPUS:85127347064
SN - 2405-4569
VL - 8
SP - 1635
EP - 1642
JO - European Urology Focus
JF - European Urology Focus
IS - 6
ER -