Prostatic Capsule‐ and Nerve‐sparing Cystectomy in Organ‐confined Bladder Cancer: Preliminary Results

Abstract

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.

The case for prostate capsule-sparing radical cystectomy in selected patients

“…This is considerably lower than the rate for cystoprostatectomy series, and clearly indicates that prostatic involvement can be identified preoperatively (Table 2). 7,[13][14][15][16][17][18][19][20][21][22] Occult prostate cancer Coexistent prostate cancer exists in patients with invasive bladder cancer at approximately the same frequency as in normal men. The risk of prostate cancer incidence or mortality is not any higher in bladder cancer patients than in the normal population.…”

“…In contrast, synchronous or metachronous prostate cancer in prostate-sparing series, where patients were screened for pre-existing prostate cancer, occurs in 2% to 4% (Table 2). 7,[13][14][15][16][17][18][19][20][21][22] Occasionally, even with this thorough screening, prostate cancer may develop. Vallancien and colleagues found that 3 of 100 men developed prostate cancer postoperatively.…”

Is sparing the prostate still considered radical cystectomy? The case against prostate-sparing cystectomy for bladder cancer

“…The continence rate for prostatesparing cystectomy in most series is excellent. [4][5][6][21][22][23][24][25][26][27] Of 10 series, 9 reported daytime continence rates of at least 94%. Nighttime continence rates were at least 94% in 6 series and all but 1 reported rates greater than 77%.…”

Therapie des Harnblasenkarzinoms

“…In einer aktuellen klinischen Serie haben Gakis et al [11] Werden die klassischen Screeninguntersuchungen (DRE, TRUS, PSA) vor rZx angewendet, kann die Rate von synchronen oder sich metachron entwickelnden Prostatakarzinomen auf 2-4% reduziert werden. In den bisher publizierten klinischen Serien zur pZx mit 369 Patienten entwickelte sich ein in der über-wiegenden Mehrzahl kleinvolumiges und günstig differenziertes, organbegrenztes Prostatakarzinom in lediglich 12 (3%) Patienten [9,12,13,14,15,16,17,18,19,20,21,22,23].…”

“…7 Werden die Patienten mit einer Tumorlokalisation am Blasenhals von der Indikationsstellung zur pZx ausgeschlossen, reduziert sich das Risiko einer Prostatabeteiligung auf 0-4% [9,12,13,14,15,16,17,18,19,20,21,22]. Bei den übrigen Patienten gilt es durch eine geeignete prä-operative oder intraoperative Diagnostik eine oberflächliche Beteiligung (muköse, duktale oder azinäre Invasion) von einer invasiven Beteiligung zu differenzieren.…”