title: Prostate capsule sparing versus nerve sparing radical cystectomy for bladder cancer: results of a randomized, controlled trial.
abstract: OBJECTIVE
  Prostate capsule sparing and nerve sparing cystectomies are alternative procedures for bladder cancer that may decrease morbidity while achieving cancer control. However, to our knowledge the comparative effectiveness of these approaches has not been established. We evaluated functional and oncologic outcomes in patients undergoing these procedures.
  
  
  METHODS
  We performed a single institution trial in patients with bladder cancer in whom transurethral prostatic urethral biopsy and transrectal prostate biopsy were negative. Men were randomized to prostate capsule sparing or nerve sparing cystectomy with neobladder creation and stratified by Sexual Health Inventory for Men score (greater than 21 vs 21 or less). Our primary end point was 12-month overall urinary function as measured by Bladder Cancer Index. Secondary end points included sexual function, cancer control and complications.
  
  
  RESULTS
  A total of 40 patients were enrolled in the study with 20 patients in each arm. Urinary function at 12 months decreased by 13 and 28 points in the prostate capsule and nerve sparing groups, respectively (p = 0.10). Sexual function followed a similar pattern (p = 0.06). There was no difference in recurrence-free, metastasis-free or overall survival (each p >0.05). The rate of incidentally detected prostate cancer was similar (p = 0.15).
  
  
  CONCLUSIONS
  Our study provides a randomized comparison of prostate capsule sparing and nerve sparing cystectomy techniques. We found no difference in functional or oncologic outcomes between the 2 approaches, although our study was underpowered due to a lack of patient accrual.
authors: Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors: Bruce L
authors: BL
authors: Jacobs
authors: Divisions of Oncology and Health Services Research, University of Michigan, Ann Arbor, Michigan.
authors: Stephanie
authors: S
authors: Daignault
authors: Divisions of Oncology and Health Services Research, University of Michigan, Ann Arbor, Michigan.
authors: Cheryl T
authors: CT
authors: Lee
authors: Divisions of Oncology and Health Services Research, University of Michigan, Ann Arbor, Michigan.
authors: Khaled S
authors: KS
authors: Hafez
authors: Divisions of Oncology and Health Services Research, University of Michigan, Ann Arbor, Michigan.
authors: Jeffrey S
authors: JS
authors: Montgomery
authors: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors: James E
authors: JE
authors: Montie
authors: Divisions of Oncology and Health Services Research, University of Michigan, Ann Arbor, Michigan.
authors: Jean E
authors: JE
authors: Humrich
authors: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors: Brent K
authors: BK
authors: Hollenbeck
authors: Department of Urology, William Beaumont School of Medicine, Royal Oak, Michigan.
authors: David P
authors: DP
authors: Wood
authors: Divisions of Oncology and Health Services Research, University of Michigan, Ann Arbor, Michigan. Electronic address: aweizer@umich.edu.
authors: Alon Z
authors: AZ
authors: Weizer
mesh_terms: D015653:Cystectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments; D011467:Prostate / Q000294:innervation*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
keywords: cystectomy; mortality; prostate; urinary bladder neoplasms; urinary diversion