Urethral wash cytopathology for monitoring patients after cystoprostatectomy with urinary diversion.

Background: Urethral wash cytopathology (UWC) has been recommended for monitoring patients after cystoprostatectomy with preservation of the penile urethra and urinary diversion. The rationale has been that early detection of urethral neoplasms (recurrences) would allow for urethrectomy to be performed before an invasive tumor developed and thus prevent or delay disease progression. Negative results of UWC would spare the patient a major surgical procedure. The authors analyzed the clinical and pathologic records of patients undergoing cystoprostatectomy with urinary diversion and preservation of the penile urethra to determine the cytohistologic correlations and to document the effect of UWC monitoring on the rate of disease progression.

Methods: All cases of men undergoing a cystoprostatectomy with urinary diversion and preservation of the penile urethra over a 12-year period at the study institution were included. Records were reviewed to determine the degree of risk associated with the pathologic findings at surgery and to document the presence or absence of disease progression for each individual. The pathologic specimens of all cases monitored with UWC were reviewed separately by both authors to establish cytohistologic correlations. Standard statistical methods were applied.

Results: Of 176 patients, urethral recurrence and disease progression occurred in both high-risk and low-risk groups. Among the 48 individuals monitored with UWC, 13 had a positive diagnosis, and 10 of these 13 had been subsequently treated with urethrectomy. Among 128 patients not monitored with UWC, 16 underwent urethrectomy. Patients in both groups had recurrent urethral neoplasms. Most lesions were focal carcinomas in situ occupying the paraurethral glands. One individual in each group had no further disease progression, even though the urethral tumor was invasive. Urethrectomy was found to have no statistically significant association with the rate of disease progression, regardless of whether the procedure resulted from a positive UWC or was provoked by patient/clinician concern. When groups were compared on the basis of monitoring with UWC, there was no statistical difference in the rate of disease progression between those monitored with UWC and those who were not. Within the monitored group, however, the cytopathologic interpretations of UWC were statistically significant; patients with positive findings were found to have the highest rate of disease progression, and those with negative findings experienced the lowest (P < 0.04).

Conclusions: Both monitoring with UWC and urethrectomy might benefit selected individuals, but neither method appeared to have a statistically significant effect on disease progression in a nonrandomized group of patients. A positive UWC was associated with a high likelihood of disease progression and could justify more intensive follow-up for progressive disease at other sites.