title: Radical cystectomy and ileal orthotopic bladder substitution after radical retropubic prostatectomy: functional and oncological results.
abstract: Men with good functional results following radical retropubic prostatectomy (RRP) and requiring radical cystectomy (RC) for subsequent bladder carcinoma seldom receive orthotopic bladder substitution. Four patients aged 62-72 years (median 67 years), who had undergone RRP for prostate cancer of stage pT2bN0M0 Gleason score 6 (n = 1), pT2cN0M0 Gleason score 5 and 6 (n = 2) and pT3bN0M0 Gleason score 7 (n = 1) 27 to 104 months before, developed urothelial bladder carcinoma treated with RC and ileal orthotopic bladder substitution. After radical prostatectomy three were continent and one had grade I stress incontinence, and three achieved intercourse with intracavernous alprostadil injections. Follow-up after RC ranged between 27 and 42 months (median 29 months). At the 24-month follow-up visit after RC daily urinary continence was total (0 pad) in one patient, two used one pad for mild leakage, and one was incontinent following endoscopic incision of anastomotic stricture. One patient died of progression of bladder carcinoma, while the other three are alive without evidence of disease. The three surviving patients continued to have sexual intercourse with intracavernous alprostadil injections. Men with previous RRP have a reasonable chance of maintaining a satisfactory functional outcome following RC and ileal orthotopic bladder substitution.
authors.affiliation: Department of Urology, University of Pisa, Pisa, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Selli
authors.forename: Gianluca
authors.initials: G
authors.lastname: Giannarini
authors.forename: Maurizio
authors.initials: M
authors.lastname: De Maria
authors.forename: Donatella
authors.initials: D
authors.lastname: Pistolesi
authors.forename: George N
authors.initials: GN
authors.lastname: Thalmann
mesh_terms: D000368:Aged; D000527:Alprostadil / Q000008:administration & dosage; D015653:Cystectomy / Q000009:adverse effects; D006801:Humans; D016496:Incontinence Pads; D007267:Injections; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000473:pathology / Q000601:surgery*; D010410:Penile Erection / Q000187:drug effects; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D012735:Sexual Dysfunction, Physiological / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods*; D014549:Urinary Incontinence / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D014554:Urination; D064804:Urological Agents / Q000008:administration & dosage
chemical_list: D064804:Urological Agents; D000527:Alprostadil