The indications for simultaneous urethrectomy during cystectomy have been recently revisited. Years ago, prophylactic urethrectomy was used in most patients who needed a cutaneous diversion. Currently, only patients with TCC at the level of the prostatic urethra or the bladder neck are considered to be at substantial risk of urethral recurrence . Since the introduction of bladder replacement techniques, the indications for prophylactic urethrectomy have become restricted. The evaluation before and during surgery of the prostatic urethra in men, and of the bladder neck in women, is the determining factor in the appropriate management strategy of the urethra in patients with bladder cancer .
However, every defunctionalized urethra after cystectomy or cystoprostatectomy is at risk of later urethral recurrence, and this risk is probably higher in patients who had a bladder substitution. Therefore there is a rationale for not leaving the urethra in situ when the patient does not get a substitute bladder, or is at high risk of recurrence because of prostatic invasion by TCC. This is the place for prophylactic urethrectomy at the time of cystectomy . Classically this urethrectomy was done through a perineal incision, but many years ago we described a prepubic urethrectomy through a caudally extended midline abdominal incision  (Fig. 1).