Seminal-sparing cystectomy: technical evolution and results over a 20-year period.
OBJECTIVE
To demonstrate the oncologic and functional results of seminal-sparing cystectomy (SSC) in patients with bladder cancer (BC) and to describe the evolution of our surgical technique over a 20-year period.


METHODS
From 1990 to 2009 we performed SSC in 88 patients with non-muscle-invasive BC and in 10 patients with muscle-invasive BC away from the bladder neck. Sixty-one of the 98 patients (1990-2002) underwent cystoadenomectomy with ileocapsuloplasty (ICP), consisting of the anastomosis between the Camey II ileal reservoir and the upper edge of the prostatic capsule. This technique was affected by a relevant percentage of anastomotic stricture (11%). From 2003 to 2009, we performed the endocapsular ileourethral anastomosis (EIUA) in 30 patients, on the basis of the direct anastomosis between the ileal reservoir and the urethral stump inside the prostatic apex. Seven patients were lost to follow-up.


RESULTS
After a mean follow-up of 102 months, 81 patients (89%) were alive, and 10 patients (11%) had died (8 of disease progression). Early and late complication rates were 25% and 24%, respectively. Complete daytime continence was obtained in 87 patients (95.6%), and nighttime continence was achieved in 34 patients (37%). In the ICP group, stricture of the prostatic fossa affected 7 patients (11%), whereas no neobladder-urethral anastomosis stricture was noticed in the EIUA group. Normal erectile function was preserved in 87 patients (95.6%).


CONCLUSIONS
SSC offers good oncologic and functional results in carefully selected patients. EIUA represents an evolution from ICP because EIUA reduces the risk of stenosis.
Department of Urology, San Giovanni Bosco Hospital, Turin, Italy.
Giovanni
G
Muto
Department of Urology, San Giovanni Bosco Hospital, Turin, Italy.
Devis
D
Collura
Department of Urology, San Giovanni Bosco Hospital, Turin, Italy.
Rodolfo
R
Rosso
Department of Urology, San Giovanni Bosco Hospital, Turin, Italy.
Alessandro
A
Giacobbe
University Campus Biomedico, Rome, Italy.
Gian Luca
GL
Muto
Department of Urology, San Giovanni Bosco Hospital, Turin, Italy. Electronic address: castelli2006@hotmail.it.
Emanuele
E
Castelli
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D015653:Cystectomy / Q000379:methods*; D018450:Disease Progression; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010410:Penile Erection; D011183:Postoperative Complications; D011467:Prostate / Q000601:surgery; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D014549:Urinary Incontinence; D016476:Urinary Reservoirs, Continent; D013520:Urologic Surgical Procedures / Q000379:methods