['We determined the value of preoperative transurethral prostatic urethral biopsy in predicting final distal urethral margin status at radical cystectomy.', 'Of 1,006 patients undergoing radical cystectomy at our institution between 1990 and 2004, 252 were men who underwent ileal neobladder and form the basis of this report. Variables collected include pathology of prostatic urethral biopsies, final pathology of the prostate, frozen section of the distal urethra, final urethral margins and survival data.', 'Median patient age was 61 years. Data regarding preoperative transurethral resection prostatic urethral biopsy and/or frozen section of the urethra at the time of surgery were available for 245 of 252 patients (transurethral resection of the prostatic urethra alone in 127, urethral frozen section alone in 68 and both in 50). The incidence of positive distal urethral margin on final pathological examination was 1.1% (3 of 252) and urethral recurrence was 0.7% (2 of 252). The correlation between transurethral resection findings and frozen section margins was only 68%, and 16 patients with positive transurethral resection findings had negative frozen section margins. The negative predictive value of transurethral resection biopsy with respect to final margins was 99.4% and that of frozen section was 100%.'] Does prostatic urethral biopsy have limited usefulness in counseling patients regarding final urethral margin status during orthotopic neobladder reconstruction?