Nerve and seminal sparing radical cystectomy with orthotopic urinary diversion for select patients with superficial bladder cancer: an innovative surgical approach.
OBJECTIVE
Radical cystectomy is advocated for high risk patients with superficial bladder cancer. To preserve complete urinary continence, normal sexual function and fertility in young patients, we developed an innovative technique based on nerve and seminal sparing radical cystectomy.


METHODS
Radical cystectomy was recommended for 8 patients with superficial bladder cancer that was not conservatively manageable. Average patient age was 44 years (range 36 to 48), and all patients were extremely anxious to maintain potency and fertility. The surgical procedure consisted of transurethral resection of the prostate, pelvic iliac lymph node dissection and extraperitoneal radical cystectomy performed while preserving the vas deferens seminal vesicles and neurovascular bundles. Urinary diversion was accomplished with a W-shaped ileal reservoir anastomosed to the prostatic capsule.


RESULTS
Patients were generally discharged from the hospital 15 days after surgery, and postoperative morbidity was limited. Daytime and nighttime continence was immediate and complete after catheter removal. Normal erectile function was clinically documented in all patients while fertility potential with semen retrieval via urine was recorded in 7. The quality of life, as reported by the patients, was highly satisfactory at 18-month followup.


CONCLUSIONS
The surgical approach we describe should be considered in young men with clinical, superficial bladder tumors refractory to conservative treatment who wish to maintain potency and fertility, and to guarantee as good a quality of life as possible. To ensure oncological success scrupulous patient selection is a primary step of this procedure.
Colombo
R
R
Department of Urology, Scientific Institute H. San Raffaele, Milan, Italy.
Bertini
R
R
Salonia
A
A
Da Pozzo
L F
LF
Montorsi
F
F
Brausi
M
M
Roscigno
M
M
Rigatti
P
P
D000328:Adult; D002278:Carcinoma in Situ / Q000503:physiopathology / Q000601:surgery*; D002295:Carcinoma, Transitional Cell / Q000503:physiopathology / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D005298:Fertility; D006801:Humans; D008297:Male; D010410:Penile Erection / Q000502:physiology; D011467:Prostate / Q000601:surgery; D011788:Quality of Life; D012669:Seminal Vesicles / Q000502:physiology; D001749:Urinary Bladder Neoplasms / Q000503:physiopathology / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D014649:Vas Deferens / Q000502:physiology