title: Fifteen-year single-centre experience with three different surgical procedures of nerve-sparing cystectomy in selected organ-confined bladder cancer patients.
abstract: OBJECTIVE
  To evaluate technical feasibility and oncologic and functional outcomes of three different surgical procedures of nerve-sparing radical cystectomy (NS-RC) for the treatment of organ-confined bladder cancer at a single referral centre.
  
  
  METHODS
  All consecutive cases of NS-RC carried out between 1997 and 2012 were retrospectively analysed. NS-RC included nerve-sparing cysto-vesicleprostatectomy (NS-CVP), capsule-sparing cystectomy (CS-C) and seminal-sparing cysto-prostatectomy (SS-CP). Peri-operative parameters and post-operative outcomes were analysed.
  
  
  RESULTS
  Overall, 90 patients underwent NS-RC, 35 (38.9 %) of whom received a NS-CVP, while 36 (40 %) and 19 (21.1 %) underwent capsule CS-C and SS-CP, respectively. No difference was registered comparing oncologic outcomes of the three different techniques; however, two local recurrences after CS-C were attributed to the surgical technique. Complete post-operative daytime and night-time urinary continence (UC) at 24 and 48 months was achieved in 94.4 and 74.4 % and in 88.8 and 84.4 % of cases, respectively. CS-C showed both the best UC and sexual function preservation rate at early follow-up (24 months). Overall, a satisfactory post-operative erectile function (IIEF-5 ≥ 22) was proved in 57 (68.6 %) and 54 (65.0 %) patients at 24 and 48 months, respectively. Significant difference was found when comparing sexual function preservation rate of NS-CVP (28.5 %) to that of CS-C (91.6 %) and SS-CP (84.2 %).
  
  
  CONCLUSIONS
  NS-RC for male patients accounted for 7.4 % of overall radical cystectomy. To a limited extent of the selected organ-confined bladder cancers treated, the three different procedures analysed showed comparable results in terms of local recurrence and cancer-specific survival. Both CS-C and SS-CP procedures provided excellent functional outcomes when compared to original NS-CVP.
authors.affiliation: Departments of Urology, Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Hospital, San Raffaele Scientific Institute, Via Olgettina, 60-20132, Milan, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Colombo
authors.affiliation: Department of Urology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Pellucchi
authors.affiliation: Departments of Urology, Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Hospital, San Raffaele Scientific Institute, Via Olgettina, 60-20132, Milan, Italy. marco.moschini87@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Moschini
authors.affiliation: Departments of Urology, Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Hospital, San Raffaele Scientific Institute, Via Olgettina, 60-20132, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Gallina
authors.affiliation: Departments of Urology, Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Hospital, San Raffaele Scientific Institute, Via Olgettina, 60-20132, Milan, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Bertini
authors.affiliation: Departments of Urology, Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Hospital, San Raffaele Scientific Institute, Via Olgettina, 60-20132, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Salonia
authors.affiliation: Departments of Urology, Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Hospital, San Raffaele Scientific Institute, Via Olgettina, 60-20132, Milan, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Rigatti
authors.affiliation: Departments of Urology, Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Hospital, San Raffaele Scientific Institute, Via Olgettina, 60-20132, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Montorsi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods*; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000502:physiology*; D011184:Postoperative Period; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D019529:Sexuality / Q000502:physiology*; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000503:physiopathology / Q000601:surgery*
keywords: Cancer-specific survival; Capsule sparing; Intrafascial prostatectomy; Nerve sparing; Radical cystectomy; Sexual function; Urinary incontinence