UROLOGICAL ONCOLOGY

Prepubic urethrectomy during radical cystoprostatectomy
Joniau S, Shabana W, Verlinde B, Van Poppel H
Department of Urology, University Hospitals Leuven, Leuven, Belgium
Eur Urol. 2007; 51: 915-21

• Objectives: In muscle-invasive bladder cancer, the risk of developing a urethral recurrence after cystectomy varies between 4% and 18%, especially when an ileal conduit is performed. For this reason, some authors advocate a urethrectomy in these indications. At our center, we developed the technique of prepubic urethrectomy. We assessed the feasibility and implications of this technique over 20 yr of use.
• Patients and Methods: We retrospectively analyzed the medical files of 180 consecutive male patients who underwent a urethrectomy simultaneously with cystectomy for invasive bladder cancer between 1985 and 2005. We describe our technique step-by-step, and present possible technical difficulties and complications of urethrectomy.
• Results: The mean increase in operative time with the prepubic urethrectomy over cystoprostatectomy alone was 17 min (range: 15-25). Postoperative complications occurred in 10 (5.5%) patients. A subcutaneous penile haematoma was noted in four (2.2%) patients, two of whom needed a circumcision later on. A scrotal haematoma was seen in five (2.7%) patients; two needed a surgical drainage and three were treated conservatively. A prepubic collection was noted in one patient who was also treated conservatively. No thromboembolic or neurologic complications were encountered.
• Conclusions: When a urethrectomy is indicated, it can best be performed by using the prepubic approach, because it is easier and less time-consuming than the perineal approach, and has very limited and easily manageable complications.
  
  
• Editorial Comment
  Urologic surgeons familiar with radical cystectomy are confronted with the risk of urethral recurrences. Indications for this procedure vary between different authors, but in cases with multifocal carcinoma in situ or clear infiltration of the prostate simultaneous urethrectomy mostly is recommended.
  These authors describe an elegant and time-saving procedure to perform prepubic urethrectomy and report their 20 years of experience.
  Remarkably, in 180 cases of en-bloc urethrectomy together with radical cystectomy the authors experienced only 10 patients with complications.
  From my own experience in many such cases I can only recommend this operative procedure and would advice anyone with experience in operative urology to thorough reading of this article.

Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany
E-mail: boehle@urologie-bad-schwartau.de