title: Prostate-sparing cystectomy: Potential functional advantages and objective oncological risks; a case series and review.
abstract: OBJECTIVE
  Prostate-sparing cystectomy (PSC) has been debated over the last decade; our aim was to assess the functional results and to evaluate the oncological outcome after PSC, to judge the value of this technique.
  
  
  METHODS
  Twenty-six men (median age 62 years) who were candidates for radical cystectomy were operated between 2004 and 2009 in the urology departments of Foch Hospital, Suresnes, France, and Theodor Bilharz Research Institute, Giza, Egypt. They all underwent a PSC with orthotopic bladder substitution. The functional results were assessed at 1, 3 and 6 months, with the final results evaluated at 1 year. Incontinence was classified according to pads used per day, and erectile function after PSC was assessed using the International Index of Erectile Function questionnaire. There was a strict follow-up for oncological failure, with special attention given to the remnant of the prostate and prostatic urethra.
  
  
  RESULTS
  The final functional results were assessed at 1 year, with daytime continence achieved in 22 patients (95%) and nocturnal leak in four (13%). At 1 year, 18 patients (83%) reported having erections on sexual stimulation. The median follow-up was 43 months, with an overall incidence of recurrence of 30% and a median time to metastasis of 30 months. At 36 months, the overall survival rate was 81%, with a tumour-free survival rate of 70%.
  
  
  CONCLUSIONS
  PSC was no better than standard radical cystectomy, and should only be offered to patients who prefer preservation of their sexual function and continence over appropriate tumour control.
authors.affiliation: Urology Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Hani
authors.initials: H
authors.lastname: Nour
authors.affiliation: Urology Department, Cairo University Hospital, Cairo, Egypt.
authors.forename: Omar
authors.initials: O
authors.lastname: Abdelrazak
authors.affiliation: Urology Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Wishahy
authors.affiliation: Urology Department, Cairo University Hospital, Cairo, Egypt.
authors.forename: Seif
authors.initials: S
authors.lastname: Elkatib
authors.affiliation: FOCH Hospital, Suresnes, France.
authors.forename: Henry
authors.initials: H
authors.lastname: Botto
keywords: Bladder cancer; CIC, clean intermittent catheterisation; Continence; Erectile function; IIEF, International Index of Erectile Function; MVAC, methotrexate, vinblastine, adriamycin and cisplatin; PDE5, phosphodiesterase-5; PSC, prostate-sparing cystectomy; Prostate-sparing cystectomy; RC, radical cystectomy