Are frozen-section examinations of ureteral margins required for all patients undergoing radical cystectomy for bladder cancer?

Unsuspected malignant disease was discovered by frozen-section examination of the ureteral margins in 8 of 403 patients (2%) undergoing cystectomy for treatment of bladder cancer. Once malignant disease was demonstrated, a short segment of the proximal ureter was resected in 6 patients; in 5 instances dysplastic changes remained at the second margin, which was anastomosed to the bowel. No clinically recognized tumor developed at this site in any of the 8 patients. In an additional 26 instances (19 patients), dysplastic changes were known to be present in the ureteral margin at the time of ureteroenteric anastomoses. Again, no recognizable tumor has developed at the anastomotic site after a median follow-up of six years. We conclude that frozen-section examinations of the ureteral margins prior to constructing the ureteroenteric anastomosis are not indicated for the patient undergoing routine cystectomy for bladder cancer, but should be reserved for patients who are at increased risk for carcinoma in situ (those with multifocal bladder carcinoma in situ or transitional cell carcinoma of the prostatic ducts).