title: Laparoscopic radical cystectomy for bladder cancer with prostatic and neurovascular sparing: initial experience.
abstract: OBJECTIVE
  This study presents our initial experience with laparoscopic radical cystectomy with preservation of the neurovascular bundles and partial prostate for the treatment of bladder cancer.
  
  
  METHODS
  Thirty-seven patients with bladder cancer were selected for the study between June 2007 and December 2009. The criteria for patient selection included prostate-specific antigen level below 4.0 ng/mL; negative involvement of the trigone and/or prostatic urethra; and no self-reported erectile dysfunction. The surgical procedure included laparoscopic prostate- and neurovascular bundles-sparing cystectomy with an ileal neobladder construction. Mean follow-up was 18 months.
  
  
  RESULTS
  All patients underwent laparoscopic resection without requiring a traditional open procedure. The mean operation time was 215 min with a mean volume of intraoperative hemorrhage of 190 mL. After removal of the urinary catheter, all patients had a daytime urinary continence; six had a short period of nighttime urinary incontinence. Most patients reported a strong desire for sexual activity and were able to complete sexual intercourse without auxiliary measures at 3 months postoperatively. Grade-3 complications developed in 2 patients graded by the classification of Clavien system. One patient was diagnosed with pelvic recurrence 16 months postoperatively.
  
  
  CONCLUSIONS
  The laparoscopic radical cystectomy with a partial prostate preservation offers the advantages of a high continence, minimal impairment of erectile function, and low recurrence rate.
authors.affiliation: Department of Urology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China. whitneyeva1@gmail.com
authors.forename: Xin
authors.initials: X
authors.lastname: Gou
authors.forename: Ming
authors.initials: M
authors.lastname: Wang
authors.forename: Wei-yang
authors.initials: WY
authors.lastname: He
authors.forename: Cao-Dong
authors.initials: CD
authors.lastname: Liu
authors.forename: Yuan-zhong
authors.initials: YZ
authors.lastname: Deng
authors.forename: Ke
authors.initials: K
authors.lastname: Ren
authors.forename: Yong
authors.initials: Y
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D001808:Blood Vessels; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D003075:Coitus / Q000502:physiology; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D007172:Erectile Dysfunction / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D059351:Organ Sparing Treatments / Q000379:methods*; D010525:Peripheral Nerves; D011467:Prostate / Q000601:surgery; D011468:Prostatectomy / Q000379:methods; D011795:Surveys and Questionnaires; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology / Q000517:prevention & control