Risk factors for concomitant involvement of the female urethra at cystectomy for malignancy

To examine the risk factors for urethral involvement in female patients after cystectomy for malignancy, a retrospective review of the records of 22 females treated with cystectomy for primary bladder malignancy were examined and analyzed with respect to presence of urethral involvement, tumor location, pathologic stage, tumor grade, lymph node status, and histologic cell type of the cancer. Of the 22 patients studied, three (13.6%) had urethral involvement in the pathologic specimens. Bladder neck tumors represented a 33% risk of urethral involvement and trigonal tumors had a 20% associated risk. Higher pathologic stage corresponded with an increased risk because 18% of stage T3b and 33% of stage T4 patients had urethral involvement. Transitional cell carcinoma was the only histologic cell type to involve the urethra and represented a 17.6% risk. Any female patient undergoing cystectomy for bladder cancer with higher stage tumors (T3b and T4) involving the bladder neck and trigone should be considered as high risk for urethral involvement and should not be considered a candidate for orthotopic neobladder reconstruction.