title: Robotic-assisted Laparoscopic Bilateral Nerve Sparing and Apex Preserving Cystoprostatectomy in Young Men With Bladder Cancer.
abstract: OBJECTIVE
  To describe our technique and outcomes of robotic-assisted nerve-sparing cystoprostatectomy with prostatic apex preservation and orthotopic ileal conduit urinary diversion in young men undergoing robotic-assisted radical cystectomy (RARC) for the management of urothelial carcinoma.
  
  
  METHODS
  Young men (<40 years old) with the diagnosis of urothelial carcinoma undergoing RARC with orthotopic neobaldder formation were eligible for our technique of nerve-sparing cystoprostatectomy with prostatic apex preservation at the time of orthotopic ileal conduit urinary diversion. During the apical prostatic dissection step of the RARC, the plane of dissection is directed under the dorsal vein complex and through anterior prostatic fibromuscular stroma. This plane is further carried through the prostatic urethra, transecting the most caudal aspect of prostatic peripheral zone posteriorly, to create a long urethra and a posterior urethral plate formed by peripheral zone of the prostate, which serves as a robust, long stump for the subsequent vesicourethral anastomosis.
  
  
  RESULTS
  From January 2013 to January 2014, 3 men were treated with RARC and intracorporeal neobladder urinary diversion based on the described technique. There were no intraoperative complications. Two patients experienced grade II complications postoperatively. Pathologic assessment demonstrated negative surgical margins in all 3 cases. With mean follow-up time of 28.2 months, 2 out of 3 patients are free from disease recurrence. All patients report daytime urinary continence with no pad usage and potency without the need for phosphodiesterase-5 inhibitors.
  
  
  CONCLUSIONS
  RARC with bilateral nerve and apical preservation can be performed safely in appropriately selected young patients with excellent functional and acceptable short-term oncologic results.
authors.affiliation: Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH. Electronic address: nyamey@ccf.org.
authors.forename: Yaw A
authors.initials: YA
authors.lastname: Nyame
authors.affiliation: Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Homayoun
authors.initials: H
authors.lastname: Zargar
authors.affiliation: Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ramirez
authors.affiliation: Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Vishnu
authors.initials: V
authors.lastname: Ganesan
authors.affiliation: Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Paurush
authors.initials: P
authors.lastname: Babbar
authors.affiliation: Department of Urology, University Hospital of Lille, France.
authors.forename: Arnauld
authors.initials: A
authors.lastname: Villers
authors.affiliation: Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
mesh_terms: D000328:Adult; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D006801:Humans; D007082:Ileum / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D059351:Organ Sparing Treatments; D011467:Prostate / Q000294:innervation; D011468:Prostatectomy / Q000379:methods*; D065287:Robotic Surgical Procedures; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods