[Prostate-sparing cystectomy: long-term functional and oncological results in a series of 25 cases].
OBJECTIVE
To decrease the risk of erectile dysfunction and incontinence by performing prostate-sparing cystectomy for bladder cancer; and to evaluate the oncological results by comparing them to those of radical cystectomy.


METHODS
Since 1994, 141 men have undergone cystectomy for bladder cancer. Twenty five patients with a mean age of 57 years (range: 47-75 years) underwent prostate-sparing cystectomy. The exclusion criteria were: contraindication to bladder replacement, invasion of the prostatic urethra, and associated prostatic adenocarcinoma. TURP was performed preoperatively to evaluate the prostatic urethra. All patients had a PSA < 4 ng/ml or negative prostatic needle biopsies. The Ditrovie and IIEF scores were used to evaluate the quality of voiding and erectile function.


RESULTS
The mean follow-up was 53.4 months (median: 46 months). The overall 5-year survival regardless of stage was 66%. Seven patients (28%) died, all from their cancer. Six patients (24%) developed a pelvic recurrence, 2 patients (8%) developed an urethral recurrence (1 had a multifocal lesion, and 1 had CIS) treated by TURP and 6 patients (24%) developed distant metastases. Among the patients with pelvic recurrence, 4 (66%) presented a multifocal tumour. One patient developed prostatic adenocarcinoma after 36 months, which was treated by external beam radiotherapy. At 1 year, 100% of patients reported normal daytime continence and 19 out of 22 patients (86.4%) were continent at night and had to get up 1 to 3 times per night. At 1 year, 10 out of 22 patients (45.4%) had normal erections, 9 (40.9%) reported impaired erectile function but allowing sexual intercourse, and 3 had major erectile dysfunction (13.6%). At 3 years, 93.7% of patients had normal daytime continence; 75% of patients were continent at night, 37.5% of patients reported normal erections, 37.5% of patients reported partial erections and 25% of patients reported major erectile dysfunction.


CONCLUSIONS
Prostate-sparing cystectomy for the treatment of invasive bladder cancer improves continence, sexual function and quality of life of patients, with poorer oncological results to those of radical cystectomy in terms of pelvic recurrence. Rigorous patient selection should improve these results.
Saidi
Abdelkader
A
Service d'Urologie, Hôpital Salvator, Marseille, France. kad1@libertysurf.fr
Nahon
Olivier
O
Daniel
Laurent
L
Lay
Franck
F
Lechevallier
Eric
E
Coulange
Christian
C
D000368:Aged; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D007172:Erectile Dysfunction / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology / Q000517:prevention & control