Urethral recurrence in patients with orthotopic ileal neobladders

Purpose: We identified the risk of urethral recurrence following cystectomy for transitional cell bladder carcinoma, stratified by pathological characteristics of the bladder tumor and type of urinary diversion. Materials and Methods: The pathological characteristics and clinical courses of 174 men with a Kock ileal neobladder and 262 with a cutaneous urinary diversion were analyzed for time to urethral recurrence. Results: Urethral recurrence was identified in 34 patients at a median of 1.6 years after cystectomy, for an overall 7.9% 5-year risk of recurrence. Carcinoma in situ (p = 0.71) and multifocality (p = 0.17) did not independently confer an increased risk of recurrence. Prostatic urethral involvement, particularly stromal invasion, significantly increased the probability of recurrence (p < 0.001). Patients with a Kock ileal neobladder had a significantly lower probability of recurrence compared to those with cutaneous diversion (p = 0.015), even when associated with prostatic urethral involvement. Conclusions: Patients with a Kock ileal neobladder have a lower risk of urethral recurrence than those with cutaneous urinary diversion, even when associated with a high risk pathological condition predicting increased risk of urethral recurrence.