title: Prostatic capsule- and seminal-sparing cystectomy for bladder carcinoma: initial results for selected patients.
abstract: OBJECTIVE
  To evaluate the oncological outcome and functional results of prostate-sparing cystectomy (PSC), proposed for treating bladder cancer, used since 1999 in our institution in an attempt to preserve male sexuality and to increase continence after cystectomy.
  
  
  METHODS
  Between January 1999 and December 2001, 111 men were candidates for cystectomy; 42 were selected for a prostatic capsule- and seminal-sparing cystectomy with orthotopic urinary diversion. All patients had clinically organ-confined tumours (clinical stage </= T2, N0M0). The first stage of the procedure was a transurethral resection of the prostate to exclude the involvement of transitional cell carcinoma (TCC) in the prostate.
  
  
  RESULTS
  Eight patients were excluded from PSC because they had TCC (seven) or prostate adenocarcinoma (one). The mean age of the remaining 34 patients was 61 years and all underwent PSC. After a mean follow-up of 26 months, seven patients (21%) had a recurrence; one developed a local recurrence, there were widespread metastases in six (18%), and five had histologically confirmed organ-confined tumour (T1-2N0M0). Rates for daytime and night-time continence were 90% and 85%, and in 29 patients potency was unchanged.
  
  
  CONCLUSIONS
  These early results suggest that PSC is not equivalent to radical cystoprostatectomy for bladder cancer control, despite marked improvements in the functional results. Moreover, in carefully selected patients this approach appears to dramatically increase an unusually high metastasis rate. Therefore, the indications for PSC should be either clearly well defined or abandoned in these patients.
authors.affiliation: Department of Urology, Hôpital Foch, Suresnes, France. t.lebret@hopital-foch.org
authors.forename: Henry
authors.initials: H
authors.lastname: Botto
authors.forename: Philippe
authors.initials: P
authors.lastname: Sebe
authors.forename: Vincent
authors.initials: V
authors.lastname: Molinie
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Herve
authors.forename: Laurent
authors.initials: L
authors.lastname: Yonneau
authors.forename: Thierry
authors.initials: T
authors.lastname: Lebret
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D002295:Carcinoma, Transitional Cell / Q000601:surgery; D015653:Cystectomy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000601:surgery*; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000601:surgery; D012669:Seminal Vesicles / Q000601:surgery*; D012735:Sexual Dysfunction, Physiological / Q000517:prevention & control; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014549:Urinary Incontinence / Q000517:prevention & control