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The aim in managing stage pT1 bladder cancer is to anticipate tumour progression when cystectomy is still curative. The concern over major life-style alterations attributed to a radical operation has largely been eliminated by the development of a “nerve-sparing” technique and bladder replacement or continent diversion. Impotence after cystectomy derives from injury to the pelvic nerve plexus that provides autonomic innervation to the corpora cavernosa. The dangerous moments of “nerve-sparing” cystectomy can be avoided by leaving both the seminal vesicles and the prostatic capsule in place. We present our series of 24 “seminal-sparing” cystectomies performed between April 1990 and April 1996 in highly selected patients with recurrent T1 bladder cancer. All the patients could achieve erections that were adequate for sexual intercourse and neither local recurrences nor distant metastases have been observed at a mean follow-up of 38 months.

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