MP23-01: Urethrectomy at the time of radical cystectomy for non-metastatic urothelial carcinoma of the bladder: a collaborative multicenter study

Ekaterina Laukhtina*, Vienna, Austria, Axelle Boehm, Tours, France, Benoit Peyronnet, Rennes, France, Carlo Andrea Bravi, Milan, Italy, Jose Batista Da Costa, Créteil, France, Francesco Soria, Torino, Italy, David D’Andrea, Fahad Quhal, Pawel Rajwa, Reza Sari Motlagh, Takafumi Yanagisawa, Frederik König, Maximilian Pallauf, Hadi Mostafaei, Tatsushi Kawada, Vienna, Austria, Dmitry Enikeev, Moscow, Russian Federation, Alexandre Ingels, Créteil, France, Gregory Verhoest, Rennes, France, Frederiek D'Hondt, Alexandre Mottrie, Aalst, Belgium, Hendrik Van Poppel, Leuven, Belgium, Alexandre De La Taille, Créteil, France, Franck Bruyère, Tours, France, Karim Bensalah, Rennes, France, Shahrokh F. Shariat, Benjamin Pradere, Vienna, Austria

Introduction: The best management of the urethra in patients planned for radical cystectomy (RC) remains unclear. We sought to evaluate the impact of concomitant urethrectomy on oncological and perioperative outcomes in patients treated with RC for non-metastatic urothelial carcinoma of the bladder (UCB).

Methods: Patients from five European University Hospitals treated with RC for UCB were retrospectively analyzed. Associations between urethrectomy with progression-free (PFS), cancer-free (CSS), and overall (OS) survivals were assessed in univariable and multivariable Cox regression models. We performed a subgroup analysis in patients at high risk for urethral recurrence (UR) such as (urethral invasion and/or bladder neck invasion and/or tumor multifocality and/or prostatic urethra involvement).

Results: A total of 887 non-metastatic UCB patients were included in the analysis. Among them, 146 patients underwent urethrectomy at the time of RC. Urethrectomy was performed more often in patients with urethral invasion, T3/4 tumor stage, CIS, positive frozen section analysis of the urethra, and those who received neoadjuvant chemotherapy, underwent robotic RC, and received an ileal conduit for urinary diversion (all p<0.001). The intraoperative complication rate, as well as estimated blood loss were comparable between urethrectomy and non-urethrectomy groups. Operative time was significantly longer in the urethrectomy group (p < 0.001). Urethrectomy at the time of RC was not associated with PFS (HR 0.83, 95% CI 0.63-1.08, p=0.17), CSS (HR 0.93, 95% CI 0.66-1.30, p=0.67), or OS (HR 1.08, 95% CI 0.83-1.40, p=0.58). In the subgroup of 276 patients at high risk for UR, urethrectomy at the time of RC was associated with improved PFS (HR 0.58, 95% CI 0.34-0.99, p=0.04).

Conclusions: In our study, urethrectomy at the time of RC seems to be beneficial only for patients at high risk for UR. Therefore, patient stratification based on UR risk should be performed before RC to help in the clinical decision-making process with counseling of the patients.

Source of Funding: None.