ORLANDO, FL (UroToday) - While urethral frozen section (FS) is routinely performed in patients with bladder cancer undergoing radical cystectomy, the utility of such FS examination is unclear. These investigators sought to examine the prevalence of distal urethral FS examination at cystectomy, its correlation with ureteric FS, and its impact on intra-operative decision making.

They identified 200 consecutive male patients diagnosed with bladder cancer who underwent radical cystectomy with either neobladder (n=121) or ileal conduit formation (n=79) from our institutional database. Of these, 43 patients did not have a FS of the urethral margins and were excluded. Demographic, clinical and pathological variables of the remaining 157 patients were examined retrospectively.

35/157 (22%) of patients had pre-operative prostatic urethral biopsy of whom 14 (40%) were positive. Of these 14 patients, 6 (43%) also had a positive distal urethral FS at cystectomy. 2/21 (10%) of patients with negative pre-cystectomy prostatic urethral biopsies had positive urethral FS at cystectomy. Overall, 17/157 (11%) of urethral FS were positive and 140 had ureteric FS, of which 16% were positive. An additional 6 patients with negative FS had final urethral margins that were positive. This yielded sensitivity for urethral FS of 74% and NPV of 96%. Among 17 patients with positive urethral FS, 6 (35%) had neobladder and 11(65%) had ileal conduit urinary diversion. The urethral FS findings did not alter the pre-operatively planned urinary diversion in any of the 14 patients for whom such data was available. Results of ureteric FS were not correlated with results of urethral FS (Fishers exact p=0.23, Table).

They conclude that the prevalence of a positive margin at the urethra on FS at cystectomy is low and similar to that of positive ureteric FS. Urethral FS results rarely altered pre-operatively planned diversion or extent of surgery. There is no correlation between the urethral FS result and the ureteric FS result. Based on these findings and the fact that many advocate eliminating ureteric FS examination, one could consider eliminating urethral FS examination as well particularly in those patients with no cystoscopic evidence of prostatic urethral involvement.

Presented by Ardalan E Ahmad, MD, Anobel Y Odisho, MD, Kirsten L Greene, MD, Maxwell V Meng, MD, Peter R Carroll, MD, Badrinath R Konety, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday Contributing Editor Christopher P. Evans, MD, FACS

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to: urotoday

Copyright © 2008 - UroToday