title: Overall clinical outcomes after nerve and seminal sparing radical cystectomy for the treatment of organ confined bladder cancer.
abstract: OBJECTIVE
  We assessed postoperative clinical outcomes such as day and nighttime urinary continence and overall sexual function in patients who underwent nerve and seminal sparing cystectomy with ileocapsuloplasty compared with patients after standard cystoprostatectomy with similar orthotopic urinary reservoir.
  
  
  METHODS
  A total of 27 patients (mean age 52 years, range 36 to 61) with superficial high risk or muscular invasive T2 bladder cancer underwent radical nerve and seminal sparing cystectomy with ileocapsule anastomosis. Postoperative clinical outcomes such as urinary continence, voiding patterns and urodynamic parameters were evaluated at 3, 6 and 12 months, while overall sexual function was determined at baseline and at 6 and 12-month followup.
  
  
  RESULTS
  Nerve and seminal sparing cystectomy provides better outcomes in terms of urinary and urodynamic parameters compared to standard cystoprostatectomy. Furthermore, fully normal postoperative erectile function and satisfactory overall sexual quality of life were documented at early and delayed followup in all patients. A retrograde ejaculation with reliable sperm retrieval from urine was also documented.
  
  
  CONCLUSIONS
  Although these findings need to be confirmed in a larger patient population, when respecting rigorous patient selection criteria and careful postoperative surveillance, nerve and seminal sparing cystectomy seems to offer satisfactory clinical and functional outcomes. From an oncological point of view, long-term followup is of paramount importance to confirm whether this surgical procedure can be proposed as a valid choice of treatment for young, fully potent and socially active patients with organ confined bladder cancer.
authors.affiliation: Department of Urology, University Vita-Salute San Raffaele, Scientific Institute H. San Raffaele, Milan, Italy. colombo.renzo@hsr.it
authors.forename: Renzo
authors.initials: R
authors.lastname: Colombo
authors.forename: Roberto
authors.initials: R
authors.lastname: Bertini
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.forename: Richard
authors.initials: R
authors.lastname: Naspro
authors.forename: Massimo
authors.initials: M
authors.lastname: Ghezzi
authors.forename: Bruno
authors.initials: B
authors.lastname: Mazzoccoli
authors.forename: Federico
authors.initials: F
authors.lastname: Deho'
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
mesh_terms: D000328:Adult; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D007172:Erectile Dysfunction / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012669:Seminal Vesicles; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000294:innervation; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics