Clinical outcome following prostatic capsule- and seminal-sparing cystectomy for bladder cancer in 25 men

Objective. To improve the functional outcome after cystectomy for bladder cancer, cystectomy was performed with a prostatic capsule- and seminal-sparing approach. This report describes the clinical outcome of the first 25 patients. Material and methods. A total of 25 male patients underwent cystectomy with preservation of the seminal vesicles, posterior prostate and neurovascular bundles. Orthotopic neobladders were used to divert the urine. At the time of last follow-up, patients were interviewed in a standard fashion to evaluate urinary, bowel and sexually related symptoms. Results. During the follow-up period (mean 72 months, range 33-129) five patients developed metastases and died of bladder cancer. Four men were diagnosed with concomitant prostate cancer. Complete day-time continence was reported in 17/20 (85%) patients. Complete nocturnal continence was seen in 10/20 (50%) men. A total of 20/21 (95%) were sexually active following prostate-sparing cystectomy. Conclusion. Prostatic capsule- and seminal-sparing cystectomy appears to combine acceptable oncological outcome with satisfactory function of the lower urinary tract; however, standard radical cystectomy still represents the gold standard.