Laparoscopic nerve- and seminal-sparing cystectomy with orthotopic ileal neobladder: the first three cases.
OBJECTIVE
Seminal and prostate sparing cystectomy represents an alternative in young patients where preservation of urinary continence and sexual potency are fundamental. We present our preliminary experience with this procedure performed laparoscopically.


METHODS
Three men-53, 58 and 49 years old-suffering from recurrent superficial transitional cell carcinoma of the bladder, resistant to intravesical therapy, underwent laparoscopic nerve, prostate and seminal vesical sparing cystectomy. One week before surgery, TURP was performed to create an adequate prostate capsule. After pneumoperitoneum induction and the positioning of five/six trocars, the ureters were clipped and transected, the vas deferens and seminal vescicles were identified and prepared for the conservative procedure. Cystectomy was performed with vascular pedicles transection by EndoGia. The reconstruction of the bladder was obtained through a 7 cm longitudinal periumbilical incision using 60 cm of ileus and an orthotopic neobladder realized outside the abdomen. The ileocapsular anastomosis was performed laparoscopically after the re-induction of pneumoperitoneum.


RESULTS
No major complications were recorded. The surgical time was respectively 480, 450 and 410 min. Blood loss was 150, 220 and 300 ml respectively. Drains were removed after 4 days (two patients) and 6 days (one patient) and the patients were discharged after 8 days (two patients) and 9 days. The patients were fully continent after catheter removal with normal uroflowmetry. At the three month follow-up they had a normal sexual function, equivalent to the preoperative assessment. The patients reported adequate erections for intercourse.


CONCLUSIONS
Laparoscopic prostate and seminal cystectomy with orthotopic ileal neobladder is a safe, feasible, reproducible surgical technique. In patients who desire to preserve sexual functioning and obtain complete continence it represents a valid alternative to classic radical cystectomy.
Department of Urology, Università Vita e Salute, San Raffaele-Ville Turro, Via Stamira D'Ancona 20, 20127 Milan, Italy. guazzoni.giorgio@hsr.it
Giorgio
G
Guazzoni
Andrea
A
Cestari
Renzo
R
Colombo
Massimo
M
Lazzeri
Francesco
F
Montorsi
Luciano
L
Nava
Andrea
A
Losa
Patrizio
P
Rigatti
D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D006801:Humans; D007082:Ileum / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D020728:Transurethral Resection of Prostate; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods; D016476:Urinary Reservoirs, Continent