Prostate Sparing Laparoscopic Radical Cystectomy

Prostate- and seminal-sparing cystectomy may be an option in young patients whose preservation of urinary continence and sexual potency are fundamental (26). In carefully selected patients, this procedure was proposed in open surgically resulting in more than 90% of patients being potent, while nearly all are totally continent, with no additional oncologic risk. In 2003, Guazzoni et al. reported the initial three cases of laparoscopic nerve- and seminal-sparing cystectomy with extracorporeally created orthotopic ileal neobladder (27). The operative time was 410 to 480 minutes, blood loss was 150-300 mL, and hospital stay was eight to nine days. All three patients were fully continent and had normal sexual functions at three months after surgery.

Cathelineau et al. reported the largest experience with laparoscopic radical cystectomy in 84 patients, including cystoprostatectomy in 31, and prostate-sparing cystectomy in 40 (28).

All patients had negative surgical margins. Pathologic staging comprised pTa-pT1 {13}, pT2 {59}, pT3 {11}, and pT4 {1}, and tumor grades were grade 1 {1}, grade 2 {13}, and grade 3 {17}. Seven patients had positive lymph nodes; numbers of retrieved nodes were not reported. Median surgical time was 4.3 hours; a median blood loss was 550 cc; median hospital stay was 12 days, with requiring parenteral narcotics for 24 hours postoperatively in 58% of patients. Urinary diversion was reconstructed extracorporeally with orthotopic bladder in 51 and ileal conduit in 33 patients. Postoperative complications were reported in 15 patients, including urinary tract infection {8}, pelvic hematoma {3}, urinary fistula {2}, pulmonary embolism {1}, and pyelonephritis {1}.

At an average follow up of 18 months (range 1-44 months), all 84 patients were alive at last follow up, and 83% were disease-free without any evidence of trocar or extraction site seeding. Eight patients developed metastatic disease, and five developed local recurrence.

Dealing With Erectile Dysfunction

Dealing With Erectile Dysfunction

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