Nerve and seminal sparing radical cystectomy with orthotopic urinary diversion for select patients with superficial bladder cancer: An innovative surgical approach

Purpose: Radical cystectomy is advocated for high risk patients with superf icial bladder cancer. To preserve complete urinary continence, normal sexua l function and fertility in young patients, we developed an innovative tech nique based on nerve and seminal sparing radical cystectomy. Materials and Methods: Radical cystectomy was recommended for 8 patients wi th superficial bladder cancer that was not conservatively manageable. Avera ge patient age was 44 years (range 36 to 38), and all patients were extreme ly anxious to maintain potency and fertility. The surgical procedure consis ted of transurethral resection of the prostate, pelvic iliac lymph node dis section and extraperitoneal radical cystectomy performed while preserving t he vas deferens seminal vesicles and neurovascular bundles. Urinary diversi on was accomplished with a W-shaped ileal reservoir anastomosed to the pros tatic capsule. Results: Patients were generally discharged from the hospital 15 days after surgery, and postoperative morbidity was limited. Daytime and nighttime co ntinence was immediate and complete after catheter removal. Normal erectile function was clinically documented in all patients while fertility potenti al with semen retrieval via urine was recorded in 7. The quality of life, a s reported by the patients, was highly satisfactory at 18-month followup. Conclusions: The surgical approach we describe should be considered in youn g men with clinical, superficial bladder tumors refractory to conservative treatment who wish to maintain potency and fertility, and to guarantee as g ood a quality of life as possible. To ensure oncological success scrupulous patient selection is a primary step of this procedure.