Laparoscopic prostate-sparing radical cystectomy: the Montsouris technique and preliminary results.
OBJECTIVE
Prostate-sparing radical cystectomy has been described in the literature and has proven to be a promising procedure because of the continence and erectile function results which does not necessarily compromise the oncologic outcome in properly selected patients. We report our preliminary results with this technique performed laparoscopically.


METHODS
A total of 25 patients with an average age of 60 years have undergone this procedure. Through a transperitoneal approach, lymph-node dissection is done with frozen-section examination, and the ureters are ligated and biopsied. The seminal vesicles are dissected, followed by complete mobilization of the bladder. Next the bladder neck is incised followed by the bladder-pedicle dissection. A simple prostatectomy can be performed if required. Finally, the neobladder is reconstructed via a small infraumbilical incision that also permits extraction of the surgical specimen. The neobladder is anastomosed to the prostate capsule.


RESULTS
The average surgical time was 285 minutes and the mean blood loss 640 mL. The complications encountered (4) were: one case each of bowel incarceration, urinary leak, lymphocele, and port-site hernia. All but one of the patients are alive at 9-month follow-up, with the one patient dying of cancer progression. No patient presented with daytime incontinence, although seven reported nocturia. There were 20 patients who maintained their preoperative sexual potency, and four described a decrease in erectile function postoperatively.


CONCLUSIONS
We have been performing laparoscopic prostate-sparing radical cystectomy for more than 2 years and have found it oncologically safe and reproducible with promising functional benefits. It presents a good option for properly selected patients.
Arroyo
Carlos
C
Department of Urology, Institut Montsouris, Université René Descartes, 42 Boulevard Jourdan, 75674 Paris cedex, France. jcak1@yahoo.com
Andrews
Henry
H
Rozet
Francois
F
Cathelineau
Xavier
X
Vallancien
Guy
G
D000328:Adult; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D015653:Cystectomy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology*; D011467:Prostate; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D016476:Urinary Reservoirs, Continent