青年人膀胱肿瘤临床病理特点及预后

目的:探讨青年人膀胱肿瘤的临床、病理特点及预后.方法:50例≤40岁青年人膀胱肿瘤患者,行经尿道膀胱肿瘤切除术39例,膀胱部分切除术治疗9例,膀胱全切+回肠代膀胱术1例,行膀胱全切术+原位新膀胱1例.结果:手术后随访半年~11年8个月,中位随访2年9个月.低度恶性倾向尿路上皮乳头状瘤复发2例;非肌层浸润性尿路上皮癌复发5例,低级别乳头状尿路上皮癌复发率为19%(3/16),进展2例;肌层浸润性尿路上皮癌复发1例.结论:青年人膀胱肿瘤良性肿瘤者比例相对较高.在青年人尿路上皮癌绝大部分为非肌层浸润性尿路上皮癌,而非肌层浸润性青年人低级别乳头状尿路复发率低于其他年龄段尿路低级别上皮癌.     

青年人膀胱肿瘤临床病理特点及预后

目的:探讨青年人膀胱肿瘤的临床、病理特点及预后.方法:50例≤40岁青年人膀胱肿瘤患者,行经尿道膀胱肿瘤切除术39例,膀胱部分切除术治疗9例,膀胱全切+回肠代膀胱术1例,行膀胱全切术+原位新膀胱1例.结果:手术后随访半年~11年8个月,中位随访2年9个月.低度恶性倾向尿路上皮乳头状瘤复发2例;非肌层浸润性尿路上皮癌复发5例,低级别乳头状尿路上皮癌复发率为19%(3/16),进展2例;肌层浸润性尿路上皮癌复发1例.结论:青年人膀胱肿瘤良性肿瘤者比例相对较高.在青年人尿路上皮癌绝大部分为非肌层浸润性尿路上皮癌,而非肌层浸润性青年人低级别乳头状尿路复发率低于其他年龄段尿路低级别上皮癌.     

改良全膀胱切除-原位回肠新膀胱术治疗膀胱癌的临床疗效(附12例报告)

目的：评价改良全膀胱切除方法和原位回肠新膀胱术的临床疗效。方法：对12例膀胱癌患者行改良全膀胱切除术．顺行分离膀胱顶部、侧壁上半部、底部,切断输尿管后改逆行分离。示指紧贴前列腺包膜将前列腺与直肠分开后,向上向外将膀胱颈部侧韧带和精囊尾的纤维束钩于示指掌握之中,切断并结扎。女性患者保留内生殖器及尿道内口。尿流改道采用原位回肠新膀胱术,并就手术并发症、术后控尿排尿情况、新膀胱容量、影像学和生化检查进行随访,随访时间8～62个月,平均35个月。结果：切除膀胱时间平均80min,术中平均出血450ml。原位回肠新膀胱控尿、排尿良好,术后静脉尿路造影、B超检查未见上尿路扩张,膀胱造影未发现输尿管反流,血生化检查正常,未发现新膀胱或尿道肿瘤复发。结论：改良膀胱切除术-原位回肠新膀胱术是治疗浸润性膀胱癌的理想方法。     

腹腔镜下保留神经血管束的膀胱根治性切除加体腔内金字塔形原位回肠新膀胱术

目的 探讨腹腔镜下膀胱根治性切除加体腔内金字塔型原位回肠新膀胱构建术的关键步骤及围术期结果。方法 患者男,49岁,3年前行经尿道膀胱肿瘤电切术（transurethral resection of bladder tumor,TURBT）,术后病理:高级别浸润性乳头状尿路上皮癌伴原位癌。术后卡介苗灌注18次,规律复查,肿瘤复发2次,分别行TURBT术,术后病理为高级别非浸润型尿路上皮癌乳头状尿路上皮癌伴原位癌。现肿瘤再次复发,PET-CT等检查提示肿瘤侵犯左输尿管口,左肾及输尿管继发积水,膀胱癌复发合并盆腔淋巴结转移。诊断:膀胱癌（T3N1M0）。行新辅助化疗（吉西他滨+顺铂）联合PD-1免疫治疗2个疗程。实施腹腔镜下保留NVB网络的膀胱根治性切除,标准盆腔淋巴结清扫及体腔内金字塔型原位回肠新膀胱重建术。关键手术步骤:（1）保留NVB网络的根治性膀胱切除:游离双侧输尿管,保留输尿管鞘膜完整,以免影响其血运和蠕动功能;游离输精管、精囊,不打开狄氏筋膜,于筋膜内间隙向前列腺尖部分离,并向两侧扩展;游离膀胱前间隙,2-0V-Loc倒刺线缝扎阴茎背深静脉复合体（dorsal vein comp...     

TUR术治疗原位新膀胱术后再发尿道癌

目的 探讨膀胱癌全膀胱切除原位新膀胱术后再发尿道癌的治疗方法.方法 膀胱癌行全膀胱切除原位新膀胱术患者89例,术后发生尿道癌5例(5.6%),再发尿道癌平均时间18(9～32)个月.5例患者病理分期为T1～T2.因复发性膀胱癌行全膀胱切除术4例,因膀胱多发癌行全膀胱切除术1例.采用乙状结肠原位新膀胱术3例,回肠原位新膀胱术2例.5例患者术后因排尿不畅(3例)、肉眼血尿(1例)、血性分泌物(1例)再次就诊.尿道镜检查发现尿道肿物位于前列腺部尿道2例、阴茎部尿道3例.肿物呈菜花状向尿道腔内生长,可见基底部,肿物直径1～3 cm.尿道镜活检报告均为尿道尿路上皮癌,病理分期为T1～T2.5例均行TUR术,术后病理报告为尿道非浸润性尿路上皮癌Ⅰ～Ⅱ级.术后辅以羟基喜树碱尿道灌注,每周1次,共6周.结果 5例TUR术后平均随访37(24～52)个月,控尿满意,血尿和血性分泌物均消失,尿细胞学检查均为阴性,尿道镜检查无阳性发现.肿瘤未见复发、转移.结论 膀胱癌膀胱全切术后再发尿道尿路上皮癌可以选择保全尿道的TUR术和尿道灌注治疗,疗效较满意且生活质量良好.     

耻骨前尿道全切术

膀胱癌是泌尿系统最常见的肿瘤之一。由于尿路上皮癌具有多中心发生特点,膀胱癌患者行根治性膀胱全切术后尿道复发的概率为5％-10％。既往主张在膀胱全切术同时行预防性尿道切除,近年来随着原位膀胱技术的发展,目前仅限于肿瘤累及后尿道或膀胱颈口时行预防性尿道切除。尿道切除术传统上多采用经会阴途径,2010年6月-2016年7月,我们对8例男性膀胱癌患者行根治性膀胱切除术的同时行耻骨前尿道全切术,现报道如下。     

腹腔镜根治性全膀胱切除回肠新膀胱术治疗浸润性膀胱癌（附30例报告）

目的 探讨腹腔镜下根治性全膀胱切除原位回肠新膀胱术的手术方法及临床疗效.方法 收集2007年5月至2011年10月应用腹腔镜下根治性全膀胱切除原位回肠新膀胱术的浸润性膀胱癌患者30例.对其临床资料进行回顾性分析和总结.结果 所有手术均获得成功,无中转开放,手术时间180～360 min（平均240 min）,术中出血量150～450mL（平均220 mL）.术后4～8d恢复肠道正常蠕动功能,随访时间6～60个月,中位随访时间26个月.30例术后均能恢复较满意的控尿功能,平均膀胱容量约398mL,平均夜尿1～3次;1例出现夜间遗尿;2例出现尿漏;膀胱镜检查无尿道肿瘤复发;2例死于原发病转移.其余患者术后随访6个月血生化指标均正常,B超检查未见上尿路扩张积水.结论 腹腔镜下根治性全膀胱切除原位回肠新膀胱术具有创伤小、出血少、盆腔淋巴结清扫彻底、术后恢复快、术后控尿满意等优点,是治疗浸润性膀胱癌的一种理想手术方式.     

腹腔镜根治性全膀胱切除回肠新膀胱术治疗浸润性膀胱癌（附30例病例报告）

目的 探讨腹腔镜下根治性全膀胱切除原位回肠新膀胱术的手术方法及临床疗效。方法 收集2007年5月至2011年10月应用腹腔镜下根治性全膀胱切除原位回肠新膀胱术的浸润性膀胱癌患者30例。对其临床资料进行回顾性分析和总结。结果 所有手术均获得成功,无中转开放,手术时间180～360 min(平均240 min),术中出血量150～450 ml(平均220 m1)。术后4～8d恢复肠道正常蠕动功能,随访时间6～60个月,中位随访时间26个月。30例术后均能恢复较满意的控尿功能,平均膀胱容量约398ml,平均夜尿1～3次;1例出现夜间遗尿; 2例出现尿漏;膀胱镜检查无尿道肿瘤复发;2例死于原发病转移。其余患者术后随访6个月血生化指标均正常,B超检查未见上尿路扩张积水。结论 腹腔镜下根治性全膀胱切除原位回肠新膀胱术具有创伤小、出血少、盆腔淋巴结清扫彻底、术后恢复快．术后控尿满意等优点,是治疗浸润性膀胱癌的一种理想手术方式。     

膀胱全切原位尿流改道术治疗膀胱非尿路上皮癌的疗效评价

目的：评价膀胱全切原位尿流改道术治疗膀胱非尿路上皮癌的疗效.方法：对17例膀胱非尿路上皮癌患者行根治性膀胱全切,盆腔淋巴结清扫;然后取一段肠管缝制成新膀胱,分别与输尿管和尿道残端吻合,实现原位尿流改道.结果：手术均获成功,手术时间172～380 min,平均310 min.16例获得随访,平均随访67个月（1～16年）.6例因肿瘤复发或转移于5年内死亡,2例死于非肿瘤因素,1例仍在随访,7例存活已达5年.结论：根治性膀胱全切原位尿流改道术治疗膀胱非尿路上皮癌,具有较好的治疗效果,能明显改善患者生活质量.     

改良根治性全膀胱切除原位新膀胱术(附9例报告)

目的探讨改良根治性全膀胱切除原位新膀胱术的临床疗效。方法采用改良全膀胱切除回肠新膀胱术治疗浸润性膀胱癌9例,均为男性,年龄40～64岁,平均55岁。尿路上皮癌8例,按WHO分级标准,Ⅱ级5例,Ⅲ级3例;腺鳞癌1例。肿瘤多发6例,均为尿路上皮癌,肿瘤最大径1.5～11.0cm。TNM临床分期:T2N0M07例,T3N0M01例,T4N1M01例。结果手术时间210～330min,平均260min。术中出血量200～800ml。输血5例,输血量400～600ml。病理分期:T2aN0M05例,T2bN0M01例,T4aN0M02例,T4N2M01例。9例患者术后均获得随访,随访时间10～64个月。7例无瘤生存,肾功能良好;2例术后2年死亡(1例腺鳞癌者死于全身转移,1例死于意外事故)。所有病例白天控尿均良好,夜间控尿良好5例,剩余尿量0～50ml。1例术后出现上尿路扩张积液、肾功能不全,为两侧输尿管末端粘连所致,经内镜下粘连松解后积液消退,肾功能恢复正常。2例年龄<50岁者,术后6个月有阴茎勃起,服用西地那非片可完成性活动。结论改良根治性全膀胱切除原位新膀胱术是治疗浸润性膀胱癌的理想方法之一。     

Management of urethral recurrence in patients with Studer ileal neobladder

OBJECTIVE: The overall risk of urethral recurrence (UR) of transitional cell carcinoma (TCC) in patients with orthotopic neobladder ranges from 2% to 6%. We are presenting herein our experience in order to evaluate and define the management of these patients, since the cases with urethral recurrence in patients with orthotopic neobladder are very scarce. MATERIALS AND METHODS: Five hundred and sixteen radical cystectomies due to TCC were performed at our Centre between January 1990 and February 1998. One hundred and thirty-eight of them (26.7%) underwent an orthotopic neobladder procedure with the Studer's technique. We are reviewing five cases of UR in patients with orthotopic neobladder, the cystectomy indications and the differences between the clinical and the pathologic stages. We are also assessing its clinical presentation, diagnosis, treatment and evolution. RESULTS: Five patients (3.6%) from 50 to 71 years old with Studer's orthotopic neobladder presented with UR. All of those neobladders were initially superficial TCC, mostly multifocal, and all had failed the endovesical treatment. Endoscopic treatment was administered in two cases with superficial UR. One patient with urethral CIS received intraurethral BCG instillations. One case because of multiplicity, and another due to the presence of an infiltrating urethral tumour, underwent urethrectomy and neobladder exeresis. In both cases, the intact 15-20cm isoperistaltic proximal ileal limb of the Studer-type orthotopic neobladder was used as an ileal conduit. CONCLUSIONS: UR in patients with orthotopic bladder substitution is unusual. A conservative approach is possible when dealing with superficial recurrences. In cases of urethrectomy, the isoperistaltic proximal ileal limb of the Studer neobladder may be used as an ileal conduit.     

Urethral recurrence after cystectomy: current preventative measures,diagnosis and management

To summarise the current literature on the diagnosis and management of urethral recurrence (UR) after radical cystectomy (RC), as UR after RC is rare but associated with high mortality. With the recently increased use of orthotopic bladder substitution and the questionable benefit of prophylactic urethrectomy, identification of patients at high risk of UR, management of the remnant urethra, and treatment of UR become critical questions. A review of the PubMed database from 1980 to 2014 was performed to identify studies evaluating recurrent urothelial cancer of the urethra after RC. The search terms used included ‘urethral recurrence’, ‘cystectomy’ or ‘cystoprostatectomy’. Selected studies provided information on the type of urinary diversion performed, the incidence of UR, and the time to UR. Incidence of UR after RC ranges from 1% to 8% with most recurrences occurring within the first 2 years after surgery. Increased risk of UR is associated with involvement of the prostate, tumour multifocality, bladder neck involvement, and cutaneous diversion. The median overall survival after UR ranges from 6 to 54 months and the 5‐year disease‐specific survival after UR is reported to be between zero and 83%. UR remains a relatively rare event. Current literature suggests that urethral wash cytology may be useful in patients with intermediate‐ to high‐risk of recurrence to enable early detection of non‐invasive disease, which may be amenable to conservative therapy before urethrectomy.     

Surgical treatment for urethral recurrence after ileal neobladder reconstruction in patients with bladder cancer

OBJECTIVE

To report a retrospective study evaluating the management of superficial urethral recurrence after ileal neobladder construction in patients with bladder cancer.

PATIENTS AND METHODS

In 77 consecutive patients with ileal neobladder after radical cystectomy for invasive bladder cancer, urethral recurrence was evaluated and transurethral resection (TUR) used as an initial treatment for superficial urethral recurrence. Urethrectomy with urinary re‐diversion was performed when further recurrence developed.

RESULTS

Four patients (5%) presented with a superficial urethral recurrence and all four were treated by TUR as initial therapy. One patient has had no evidence of recurrence after initial TUR, although the other three patients were later treated with salvage urethrectomy due to repeated urethral recurrence. As a result, the stage of urethral recurrence advanced from pTa to pT1–pT2 in two of the three patients. For urinary re‐diversion, one patient had a conversion from a Studer pouch to an ileal conduit, using the afferent limb, and the other two were converted from a Hautmann pouch to a continent reservoir using the Appe‐Mainz procedure. There was no evidence of metastasis or local recurrence in any of the four patients.

CONCLUSION

Urethral preservation at initial therapy for superficial recurrence might be reasonable, and sequential urethrectomy after attempted urethral preservation might be strategically feasible. Urinary re‐diversion from a neobladder to a catheterizable continent reservoir using the appendix would be a good choice and maintains the quality of life.

     

Urethral tumor recurrence following cystectomy and urinary diversion: clinical and pathological characteristics in 768 male patients

PURPOSE: We evaluated the incidence and risks of urethral recurrence following radical cystectomy and urinary diversion in men with transitional cell carcinoma of the bladder. MATERIAL AND METHODS: Clinical and pathological results were evaluated in 768 consecutive male patients undergoing radical cystectomy with intent to cure for bladder cancer with a median followup 13 years, including 397 (51%) who underwent orthotopic urinary diversion with a median followup of 10 years and 371 (49%) who underwent cutaneous urinary diversion with a median followup of 19 years. Demographically and clinically these 2 groups were well matched with the only exception being longer median followup in the cutaneous group (p <0.001). Urethral recurrence was analyzed by univariate and multivariable analysis according to carcinoma in situ, tumor multifocality, pathological characteristics (tumor grade, stage and subgroup), the presence and extent of prostate tumor involvement (superficial vs stromal invasion) and the form of urinary diversion (cutaneous vs orthotopic). RESULTS: A total of 45 patients (6%) had urethral recurrence at a median of 2 years (range 0.2 to 13.6), including 16 (4%) with an orthotopic and 29 (8%) with a cutaneous form of urinary diversion. Carcinoma in situ and tumor multifocality were not significantly associated with an increased risk of urethral recurrence (p = 0.07 and 0.06, respectively). The presence of any (superficial and/or stromal invasion) prostatic tumor involvement was identified in 129 patients (17%). Prostate tumor involvement was associated with a significantly increased risk of urethral recurrence (p = 0.01). The estimated 5-year chance of urethral recurrence was 5% without any prostate involvement, increasing to 12% and 18% with superficial and invasive prostate involvement, respectively. Patients undergoing orthotopic diversion demonstrated a significantly lower risk of urethral recurrence compared with those undergoing cutaneous urinary diversion (p = 0.02). Patients without any prostate tumor involvement and orthotopic diversion (lowest risk group) demonstrated an estimated 4% year chance of urethral recurrence compared with a 24% chance in those with invasive prostate involvement undergoing cutaneous diversion (highest risk group). On multivariate analysis any prostate involvement (superficial and/or invasive) and urinary diversion form remained independent and significant predictors of urethral recurrence (p = 0.035 and 0.01, respectively). CONCLUSIONS: At long-term followup urethral tumor recurrence occurs in approximately 7% of men following cystectomy for bladder transitional cell carcinoma. Involvement of the prostate with tumor and the form of urinary diversion were significant and independent risk factors for urethral tumor recurrence. Patients undergoing orthotopic diversion have a lower incidence of urethral recurrence compared with those undergoing cutaneous diversion. Although prostate tumor involvement is a risk factor for urethral recurrence, it should not preclude orthotopic diversion, provided that intraoperative frozen section analysis of the urethral margin is without evidence of tumor.     

体外协助尿流改道的腹腔镜全膀胱根治性切除术

目的 探讨体外协助尿流改道的腹腔镜全膀胱根治性切除术的疗效.方法 2006年6月～2012年6月施行体外协助尿流改道的腹腔镜全膀胱根治性切除术28例,全膀胱切除和盆腔淋巴结清扫均在腹腔镜下完成,标本自下腹部小切口取出,体外协助尿流改道采用回肠膀胱术（Bricker手术）和原位回肠新膀胱2种术式,其中Bricker手术22例、原位回肠新膀胱术6例.结果 均一次手术成功,腹腔镜盆腔淋巴结清除及全膀胱切除手术时间150～240 min,平均180 min;体外协助尿流改道时间90～270 min,平均150 min;术中出血200 ～900 ml,平均350 ml;肠功能恢复时间3～4d.6例原位回肠新膀胱2～4周拔除导尿管,能正常排尿,无尿潴留和肾功能损害发生.26例随访6～36个月,平均15个月,1例术后23个月死于复发及远处广泛转移,2例死于其他内科疾病,其余患者一般情况良好,未见肿瘤复发及转移.结论 体外协助尿流改道的腹腔镜全膀胱根治性切除术疗效满意.     

膀胱癌膀胱全切术后尿道复发的风险评估及对策

目的 探讨膀胱癌膀胱全切术后尿道复发的危险因素及处理方法。方法 回顾分析278例膀胱癌膀胱全切患者的临床资料，其中24例发生了尿道复发。运用cox’s多因素回归模型对影响复发的危险因素进行评价。结果 6例选择性尿道切除者无1例死于肿瘤；24例尿道复发者10例死于肿瘤转移。多因素分析表明前列腺受累、膀胱颈受累、三角区肿瘤、多发肿瘤和原位癌是影响尿道复发的危险因素，相对危险度分别为1．573，1．532，1．360，1.337和1．213。结论 前列腺受累、膀胱颈受累、三角区肿瘤、多发肿瘤或原位癌是预防性尿道切除术的指征。保留尿道的患者宜尽量行正位排尿的尿流改道术。     

女性保留内生殖器膀胱全切原位回肠新膀胱尿流改道术的临床疗效

目的:探讨女性保留内生殖器膀胱全切患者行原位回肠新膀胱尿流改道术的临床疗效。方法:回顾性分析我院2005年7月~2012年5月48例女性膀胱肿瘤患者的临床资料,均采取保留内生殖器的膀胱全切术并行原位回肠新膀胱尿流改道术。48例患者中移行细胞癌46例,腺癌2例;原发肿瘤32例,复发性肿瘤16例;多发性非肌层侵犯肿瘤17例,肌层浸润性膀胱肿瘤31例。结果:48例患者的平均手术时间260(210~360)min,平均输血量280(0~1200)ml。术后47例患者获得随访,随访6~84个月,平均36个月。术后12个月白天控尿率为97.9%(46/47),夜间控尿率为93.6%(44/47)。新膀胱尿道吻合口漏3例。术后6个月IVU检查输尿管狭窄2例。无子宫、子宫附件及阴道转移复发。结论:对于符合适应证的女性膀胱癌患者,保留内生殖器、阴道前壁、自主神经及完整尿道,行膀胱全切并行原位回肠新膀胱尿流改道术,临床疗效满意,术后患者生活质量高,可作为广泛开展的术式。     

Risk factors and outcomes of urethral recurrence following radical cystectomy

Background

Conflicting data exist regarding predictors of urethral recurrence (UR) following radical cystectomy (RC) as well as variables associated with survival in patients who experience UR.

Objective

To evaluate the incidence, risk factors, and outcomes of patients with UR.

Design, setting, and participants

We reviewed 1506 patients who underwent RC to identify patients with UR. Median follow-up after RC was 13.5 yr (interquartile range [IQR]: 10.5–18.4).

Intervention

Urethrectomy.

Measurements

Cox proportional hazard regression models were used to analyze predictors of UR and evaluate factors associated with death from urothelial carcinoma (UC) in patients who experienced UR. Cancer-specific survival (CSS) for patients with UR, stratified according to the mode of diagnosis (abnormal urethral cytology vs symptoms), was estimated using the Kaplan-Meier method and compared with the log-rank test.

Results and limitations

UR was identified in 85 patients (5.6%) at a median of 13.3 mo (IQR: 6.1–23.2) after RC, including 80 of 1243 (6.4%) who underwent cutaneous urinary diversion and 5 of 242 (2.1%) who received an orthotopic neobladder (p = 0.002). On multivariate analysis, prostate involvement with UC (hazard ratio [HR]: 4.89; p < 0.0001), bladder tumor multifocality (HR: 2.34; p = 0.001), and orthotopic diversion (HR: 0.34; p = 0.02) were significantly associated with the risk of UR. The 5-yr CSS after UR diagnosed by cytology was 80% versus 41% for patients who presented with symptoms (p < 0.0001). Patients with symptomatic UR were noted to have significantly higher stage disease at urethrectomy (p = 0.04) and tended toward an increased risk of death from UC (HR: 1.94; p = 0.08). Limitations included retrospective study design.

Conclusions

Prostate involvement with UC, tumor multifocality, and type of urinary diversion are significantly associated with UR following RC. Although UR is relatively uncommon, the detection of asymptomatic UR was associated with significantly lower stage disease and improved patient survival, suggesting the importance of continued postoperative evaluation of the urethra.     

腹腔镜下根治性膀胱切除回肠新膀胱术（附15例报告）

目的介绍腹腔镜下根治性膀胱切除回肠新膀胱术的方法及经验。方法本组15例，均为男性，年龄45～62岁，平均54岁。术前均明确诊断为浸润性膀胱癌。采用腹腔镜下行膀胱癌根治性切除，然后取长约40cm回肠于体外缝制贮尿囊及输尿管贮尿囊吻合，体内行贮尿囊尿道吻合术。结果手术时间5．5～8h，平均6．5h；出血量200～1100ml，平均550ml。术后8周静脉尿路造影以及代膀胱造影检查显示：双肾显影良好，无输尿管返流及梗阻，代膀胱充盈良好，容量约300ml。术后3个月全部患者日间控尿良好，7例患者夜间控尿良好，夜间排尿2～3次。结论腹腔镜下膀胱全切除、体外建成贮尿囊及输尿管再植、体内贮尿囊尿道吻合术创伤小、出血少、术后尿控率高、恢复快。     

Diagnosis and treatment of urethral recurrence after radical cystectomy in the male

ContextFrom 4%-6% of males subjected to radical cystectomy due to urothelial carcinoma will have urethral recurrence (UR) during the follow-up.ObjectiveTo analyze the diagnosis, treatment and course of the patients with UR following a cystectomy.Acquiring of evidenceAnalysis of original articles and reviews related with the diagnosis, treatment and course of patients subjected to radical cystectomy and who develop UR. The articles were obtained from a search in PubMed.Synthesis of evidenceMost of the UR appear during the first 3 years of the cystectomy. Approximately 50% of the URs of contemporary series were diagnosed through urethral cytology, the patient being asymptomatic. The urethrectomy is the treatment of choice in patients with UR and cutaneous diversion. In patients with orthotopic bladder replacement (OBR): 1) the treatment of the intraurethral BCG can be useful in patients with carcinoma in situ (CIS), 2) papillary type conservative treatment in UR has contradictory results, 3) when the uretrectomy is necessary, the ileal duct or conversion of the OBR in a continent urinary derivation can be used.ConclusionsUrethral cytology is a test having high sensitivity and can contribute to the diagnosis of UR in the earliest stages. In patients with OBR, the diagnosis of a UR is a therapeutic challenge. The bladder tumor, urethral recurrence and presence of an upper urinary tract tumor in 25% of the cases may be a cause of death in these patients.