Radical perineal prostatectomy is an excellent alternative approach for radical surgery in the treatment of early prostate cancer.

We present a novel radical cystectomy technique that allows bladder cancer control while maintaining urinary continence and reducing the risk of erectile dysfunction by sparing the prostatic capsule and the neurovascular bundles. Between September 1997 and December 2002, 85 men were candidates for cystectomy; 32 were selected for a prostatic capsule- and seminal-sparing cystectomy with orthotopic urinary diversion. All patients had clinical organ-confined bladder cancer (cT1 to cT3a). One patient died of unrelated causes. Of the remaining 31 patients, two with pT4, N+ disease underwent three cycles of adjuvant chemotherapy and are free of disease at 10 and 12 months postoperatively. Twenty-nine patients with organ-confined bladder cancer are free of disease after a mean follow-up of 32 months. At 24 months, 98% of the patients are completely continent during the day and 83% during the nighttime hours. In addition, 80% of the patients are able to complete sexual intercourse without auxiliary measures at a mean of 24 months postoperatively. Prostatic capsule- and nerve-sparing cystectomy permits en bloc removal of the bladder, of the adenomatous prostatic tissue, and of the seminal vesicles, thereby achieving local cancer control and preserving erectile function and urinary continence.

Our preliminary results with a bipolar electrode for electrovaporization of the prostate using the Gyrus suggest that it is a useful and safe endoscopic device.