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Treatment of Urethral Cancer Associated With Invasive Bladder Cancer
Source: Urethral Cancer Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: July 19, 2024 · Captured 2026-09-09.
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Approximately 10% (range, 4%–17%) of patients who undergo cystectomy for bladder cancer can be expected to have or to later develop clinical neoplasm of the urethra distal to the urogenital diaphragm. Factors associated with the risk of urethral recurrence after cystectomy include the following:[1,2]
Tumor multiplicity.
Papillary pattern.
Carcinoma in situ.
Tumor location at the bladder neck.
Prostatic urethral mucosal or stromal involvement.
The benefits of urethrectomy at the time of cystectomy need to be weighed against the morbidity factors, which include added operating time, hemorrhage, and the potential for perineal hernia. Tumors found incidentally on pathological examination are much more likely to be superficial or in situ in contrast to those that present with clinical symptoms at a later date, when the likelihood of invasion within the corporal bodies is high. The former lesions are often curable, and the latter are only rarely so. Indications for urethrectomy in continuity with cystoprostatectomy are the following:
Visible tumor in the urethra.
Positive swab cytology of the urethra.
Positive margins of the membranous urethra on frozen section taken at the time of cystoprostatectomy.
Multiple in situ bladder tumors that extend onto the bladder neck and proximal prostatic urethra.
If the urethra is not removed at the time of cystectomy, follow-up includes periodic cytologic evaluation of saline urethral washings.[2]
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Treatment options for urethral cancer associated with invasive bladder cancer include the following:
In continuity cystourethrectomy.
Monitor urethral cytology and delayed urethrectomy, if necessary.
The level of evidence for these treatment options is Level of evidence C3.
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Preserved source evidence · Not medical advice