Radical cystectomy with preservation of sexual function and fertility in patients with transitional cell carcinoma of the bladder: new technique.
OBJECTIVE
Radical cystectomy is the standard treatment for patients with invasive bladder carcinoma. Preservation of sexual function and fertility are important for surgery acceptance in young patients with this disease, and part of the prostate is generally preserved for this reason; however, this may compromise the radical nature of the surgery. Herein a novel technique of radical cystectomy with preservation of the vas deferens only is described aimed at preservation of sexual function and better cancer control.


METHODS
Between March 2002 and February 2004, four potent male patients with muscle invasive transitional cell carcinoma of the bladder underwent nerve-sparing radical cystectomy with urinary diversion. The bladder, prostate with prostatic urethra, regional lymph nodes and seminal vesicles were removed while the vas deferens was preserved until its terminal end and anastomosed (in the perineum) to the bulbar urethra (end to side). The diversion was ureterocolic in three patients and ileal conduit in one patient. The median age of the patients was 45.0 years (range 35-55). The mean follow-up was 35.5 months (range 23-46 months).


RESULTS
There was no mortality. All patients were free of the disease (no local or distant recurrence) at the last follow-up. All patients reported adequate sexual function with normal erections and satisfactory intercourse similar to that reported before surgery. Two patients maintained antegrade ejaculation allowing procreation in one case.


CONCLUSIONS
This technique allows preservation of sexual function in nearly all cases with better oncological outcome than any other techniques of radical cystectomy aimed at preservation of sexual function.
Salem
Hosni Khairy
HK
Kasr El Einy Hospital, Urosurgery Department, Egypt. dr_hosni@yahoo.com
D000328:Adult; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D005298:Fertility; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000502:physiology*; D013076:Sperm Count; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014649:Vas Deferens