Introduction
Incidence of urethral recurrence (UR) following radical cystoprostatectomy (RC) is estimated at 4-8%. UK NICE Guidelines recommend annual urethral cytology and/or urethroscopy for 5 years post-cystectomy, with EAU Guidelines also advocating urethroscopic surveillance. However, evidence to support these recommendations is lacking. Indeed, evidence is conflicted regarding improved outcomes following asymptomatic detection on surveillance compared with symptomatic self-presentation. Our centre, one of the UK’s highest volume cystectomy centres, adopts a risk-stratified approach whereby high-risk patients undergo prophylactic urethrectomy. Patients with preserved urethrae are enrolled into our surveillance programme. We evaluated our 5-year incidence and mode of detection for UR with the aim of informing an improved surveillance strategy.

Methods
Men undergoing RC for urothelial carcinoma January 2011 - October 2016 were identified from a prospective database. Histopathology and cytology reports were reviewed.

Results
RC was performed in 491 patients, with 60 orthotopic reconstructions. Prophylactic urethrectomy was performed in 49 patients. Urethrectomy for suspected recurrence was performed in 17 patients: 13 confirmed malignant, 4 benign. UR incidence at 2 and 5-years was 2.6% and 4.4%. Four recurrences presented symptomatically. Asymptomatic recurrences were detected on urethroscopy with cytology obtained in 5 patients (4 confirmatory, 1 inconclusive).

Conclusion
UR incidence in our centre is low, perhaps in part due to risk-stratified prophylactic urethrectomy. The majority of recurrences were identified on urethroscopic surveillance although some presented symptomatically despite surveillance. Future cost-effectiveness analysis will be important to evaluate the role of urethroscopic surveillance in detecting post-cystectomy UR.