Prostatic capsule‐ and seminal‐sparing cystectomy for bladder carcinoma: initial results for selected patients

Botto, Henry; Sèbe, Philippe; Molinié, Vincent; Hervé, Jean-Marie; Yonneau, Laurent; Lebrét, Thierry

doi:10.1111/j.1464-410x.2004.05097.x

Cited by 73 publications

(43 citation statements)

References 35 publications

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“…With regard to functional outcome, the overall postoperative potency preservation rates of the PSC series were 80%-94% and complete day-time and night-time urinary continence rates were close to 100% and 90%, respectively [29][30][31][32][33]. These rates are significantly superior to those described after standard cystoprostatectomy.…”

Section: Mainlan Chinamentioning

confidence: 71%

Prevalence of incidental prostate cancer in patients undergoing radical cystoprostatectomy: data from China and other Asian countries

Zhu¹,

Ye²,

Yao³

et al. 2008

Asian J Androl

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The purpose of this study is to investigate the frequency of prostate cancer (Pca) discovered incidentally in radical cystoprostatectomy specimens in Asia and to determine the feasibility of prostate-sparing cystectomy (PSC) for Asian patients. Ninety-two male bladder cancer patients who underwent radical cystoprostatectomy at our center between January 2003 and January 2008 were included in this study. The mean age of patients was 67.1 years (range: 32-75 years). Prostate-specific antigen (PSA) levels and digital rectal examination (DRE) results before surgery were obtained retrospectively. Prostates of all patients were embedded and sectioned at 5-mm intervals. The same pathologist examined the prostatic tissues from radical cystoprostatectomy specimens. Finally, a structured literature review was performed using MEDLINE and PUBMED to estimate the occurrence of incidental Pca in Asia. Of the 92 patients, 3 (3.3%) were found to have Pca; in one out of three (33.3%) patients the disease was clinically significant due to a Gleason grade 4 carcinoma. Eight articles were included in our review. The overall incidence of Pca discovered incidentally in radical cystoprostatectomy specimens in Asia was 9.9% (64/642). When age was restricted to < 60 years, only 7 out of 222 (3.2%) patients were found to have synchronous Pca, and none of the cases was clinically significant. The occurrence of Pca in radical cystoprostatectomy specimens in Asia is much lower than that in Western countries. PSC might be feasible for Asian patients under a strict preoperative selection.

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Section: Mainlan Chinamentioning

confidence: 71%

Prevalence of incidental prostate cancer in patients undergoing radical cystoprostatectomy: data from China and other Asian countries

Zhu¹,

Ye²,

Yao³

et al. 2008

Asian J Androl

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“…Thirty-five patients had a prostatic capsuleand seminal-sparing cystectomy. They were independently studied [10] and were excluded from this study. The mean age of the 294 remaining patients was 64.4 ± 9.6 years.…”

Section: Patient Populationmentioning

confidence: 99%

The Z‐shaped ileal neobladder after radical cystectomy: an 18 years experience with 329 patients

et al. 2011

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Eighty-three early complications in 80/294 patients (27.2%) occurred. The average Clavian rate of these early complications was 2.24. Among these, 12 complications in 12 patients (4.1%) were pouch-related, and 3 reoperations were required. Two patients died from cardiac complications. Sixty-three late complications in 60/294 patients (20.4%) were recorded. The average Clavian rate of these late complications was 2.98. Among these, 47 complications in 45/294 patients (15.3%) were pouch-related, and 18 reoperations were required, essentially for ureteral anastomosis stricture.Satisfactory daytime urinary continence was achieved in 92% of patients. Daytime continence was obtained within, on average, 6.8 ± 16.4 months. The interval between each daytime urination was 2.6 ± 0.8 h (median = 2.5 [1-5] h). Forty-four (15%) patients developed metabolic acidosis which only required oral medication.Satisfactory nocturnal urinary continence was achieved in 87% of patients. Night-time continence was obtained within, on average, 10.8 ± 22.4 months.Hyper-continence with subsequent need for CISC was observed in 4%. CONCLUSIONIn our series of 329 patients, compared with the other techniques, the Z-shaped ileal neobladder had an 'expected' complication rate for this high risk surgery with satisfactory daytime and night-time continence in nine out of ten patients.

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“…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.…”

Section: Prostatic Involvement By Tccmentioning

confidence: 99%

“…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.…”

Section: Prostatic Involvement By Tccmentioning

confidence: 99%

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

Klotz

Pinthus

2013

CUAJ

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Can Urol Assoc J 2009;3(Suppl4): S215-9 R adical cystoprostatectomy and neobladder replacement have become the gold standard for patients with invasive bladder cancer. Although the neobladder represents a significant improvement over ileal conduit, in terms of the effect on body image, the operation has a significant impact on many quality-of-life-related domains. Erectile function and incontinence (particularly nocturnal) are common. Nerve-sparing cystectomy is associated with a relatively low rate of erectile function preservation. 1 The impetus for traditional cystectomy including en bloc dissection of the entire prostate arose because of reports that occult transitional cell carcinoma (TCC) and prostate cancer were prevalent in the prostate of these men. In this article, we present the case that prostate capsule-sparing radical cystectomy, with appropriate and careful patient selection and surgical technique reduces the risk of local recurrence and improves quality of life. Prostate-sparing techniquesDifferent techniques have been described, with several common motifs. All of these techniques preserve a portion of the prostatic capsule, the seminal vesicles and the vas deferens, but vary in the types of prostate resection and neobladder configuration. 2 Importantly, all authors advocate removal of part of the prostate. "Prostate sparing" actually refers either to subtotal prostatic resection or resection of the adenoma with capsule sparing.The two main techniques are (1) removal of the prostatic adenoma using the technique of a Millen simple retropubic prostatectomy, excising the adenoma tissue containing the prostatic ducts and most acini, leaving the surgical capsule and seminal vesicles intact, 3 and (2) a transverse excision through the proximal prostate, leaving the distal prostate, including the distal adenoma and seminal vesicles and utricle, intact. 4 In both cases, the neurovascular bundle, the distal sphinteric complex, and the continuity of the vas, seminal vesicles and ejaculatory duct remain undisturbed.The critical two questions are (1) What is the risk of local recurrence in the residual prostate tissue? and (2) What are the quality-of-life results (e.g., voiding, continence and erectile function)?Patient selection is a critical component of the procedure. Patients who are at increased risk for prostatic urethral involvement should be excluded. Identifying these patients involves several steps. Patients should be candidates for a neobladder on the basis of age, comorbidity, and extent of disease. T4 cases are excluded. The primary cancer should not directly involve the bladder neck or prostatic urethra. Diffuse, multifocal carcinoma in situ (CIS) increases the risk of prostatic involvement and is a contraindication. (Focal CIS in the peri-tumoural area is not a contraindication.) Patients who have no CIS, multifocality or bladder neck involvement have an extremely low rate of prostatic urethral involvement; in one series, 0 of 40 patients experienced prostatic urethral involvement. 5

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Prostatic capsule‐ and seminal‐sparing cystectomy for bladder carcinoma: initial results for selected patients

Cited by 73 publications

References 35 publications

Prevalence of incidental prostate cancer in patients undergoing radical cystoprostatectomy: data from China and other Asian countries

Prevalence of incidental prostate cancer in patients undergoing radical cystoprostatectomy: data from China and other Asian countries

The Z‐shaped ileal neobladder after radical cystectomy: an 18 years experience with 329 patients

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

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