title: Nerve Sparing, Robot-Assisted Radical Cystectomy with Intracorporeal Bladder Substitution in the Male.
abstract: We provide a step-by-step description of our technique of nerve and seminal vesicle sparing robot-assisted radical cystectomy with an orthotopic neobladder. We also present preliminary oncologic and functional outcomes.
  
  
  
  Nerve and seminal vesicle sparing robot-assisted radical cystectomy with a modified Y-shaped orthotopic neobladder was performed by the same surgeon in 40 men with clinically localized bladder cancer from January 2011 to September 2014. Operative, perioperative and pathological data as well as continence and erectile function outcomes are presented.
  
  
  
  Median followup was 26.5 months (range 8 to 52). A soft tissue positive surgical margin was found in a patient with pT3a disease. A global rate of 30% early and 32.5% late complications was observed. However, the grade III or higher complication rate was low in both settings at 2.5% and 5%, respectively. There was 1 cancer related death 23 months after surgery. Of the 40 patients 30 (75%) gained daytime continence (0 pad) within 1 month postoperatively. The 12-month nocturnal continence rate was 72.5% (29 of 40 patients). Mean preoperative IIEF-6 (International Index of Erectile Function-6) score was 24.4. Erectile function returned to normal, defined as an IIEF-6 score greater than 17, in 31 of 40 patients (77.5%) within 3 months while 29 of 40 patients (72.5%) returned to the preoperative IIEF-6 score within 12 months.
  
  
  
  In the hands of an experienced surgeon nerve and seminal vesicle sparing robot-assisted radical cystectomy with intracorporeal reconstruction of the neobladder seems feasible and safe. It provides short-term oncologic efficacy and promising functional outcomes. Yet comparative, long-term followup studies with standard open cystectomy are required.
authors.affiliation: Department of Urology, Clinique Saint-Augustin, Bordeaux, France. Electronic address: tasospao2003@yahoo.com.
authors.forename: Anastasios D
authors.initials: AD
authors.lastname: Asimakopoulos
authors.affiliation: Department of Urology, Clinique Saint-Augustin, Bordeaux, France.
authors.forename: Adriano
authors.initials: A
authors.lastname: Campagna
authors.affiliation: Department of Urology, Clinique Saint-Augustin, Bordeaux, France.
authors.forename: Georgios
authors.initials: G
authors.lastname: Gakis
authors.affiliation: Department of Urology, Clinique Saint-Augustin, Bordeaux, France.
authors.forename: Victor Enrique
authors.initials: VE
authors.lastname: Corona Montes
authors.affiliation: Department of Urology, Clinique Saint-Augustin, Bordeaux, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Piechaud
authors.affiliation: Department of Urology, Clinique Saint-Augustin, Bordeaux, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Hoepffner
authors.affiliation: Department of Urology, Clinique Saint-Augustin, Bordeaux, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Mugnier
authors.affiliation: Department of Urology, Clinique Saint-Augustin, Bordeaux, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Gaston
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods*; D005837:Genitalia, Male / Q000294:innervation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D012669:Seminal Vesicles; D016476:Urinary Reservoirs, Continent; D013521:Urologic Surgical Procedures, Male / Q000379:methods
keywords: cystectomy; penile erection; robotics; urinary bladder; urinary diversion