Abstract | PURPOSE: With the introduction of orthotopic bladder substitution after radical cystectomy in patients with invasive bladder cancer urethral recurrences have become a therapeutic challenge. MATERIALS AND METHODS: We retrospectively evaluated our patients with urethral recurrences treated with a urethra sparing approach after orthotopic bladder substitution. Depending on the extension of recurrence and eventual concomitant metastases patients were treated with urethrectomy, no treatment, systemic chemotherapy or intraurethral bacillus Calmette-Guerin (BCG). Three times the common dose of BCG ( ImmuCyst, Aventis, Paris, France or OncoTICE, Organon, West Orange, New Jersey) in 150 ml NaCl 0.9% was used for intraurethral BCG perfusion therapy according to an institutional protocol using a modified Foley catheter. This regimen was repeated weekly for 6 weeks and patients were followed prospectively. RESULTS: Between 1985 and 2001, 15 of 371 patients (4%) who received an orthotopic bladder substitute had urethral recurrence. Two patients were treated with systemic chemotherapy ( methotrexate, vinblastine, doxorubicin and cisplatin) alone due to metastatic disease and 10 received intraurethral BCG therapy. Five of 6 patients (83%) with carcinoma in situ remained free of recurrence following treatment with BCG, while in 4 with papillary or invasive disease treatment failed. Three patients underwent urethrectomy, including 2 following failed BCG therapy for papillary disease. CONCLUSIONS:
Carcinoma in situ urethral recurrence following orthotopic bladder substitution can be treated successfully with intraurethral BCG perfusion therapy in approximately 80% of patients. However, papillary and invasive transitional cell urethral recurrence should be treated with urethrectomy.
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Authors | Celi Varol, George N Thalmann, Fiona C Burkhard, Urs E Studer |
Journal | The Journal of urology
(J Urol)
Vol. 172
Issue 3
Pg. 937-42
(Sep 2004)
ISSN: 0022-5347 [Print] United States |
PMID | 15311003
(Publication Type: Journal Article)
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Chemical References |
- Antineoplastic Agents
- BCG Vaccine
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Topics |
- Aged
- Antineoplastic Agents
(therapeutic use)
- BCG Vaccine
(administration & dosage)
- Carcinoma, Transitional Cell
(diagnosis, secondary, therapy)
- Cystectomy
- Humans
- Male
- Middle Aged
- Urethra
(surgery)
- Urethral Neoplasms
(diagnosis, secondary, therapy)
- Urinary Bladder Neoplasms
(pathology, surgery)
- Urinary Reservoirs, Continent
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