SEMINAL SPARING ORTHOTOPIC NEOBLADDER.

Objective

Bladder cancer remains an important and hard to treat pathology in modern urology, as it is considered the most expensive tumour with regard to both costs per patient per year, as well as lifetime costs per patient. Standard radical cystectomy, represents the gold standard in the treatment of infiltrating carcinoma and high-risk superficial bladder cancer. In male patients, the standard surgical procedure envisages removal of bladder, prostate, seminal vescicules and deferentia, and when possible, subsequent creation of an orthotopic bladder. This study aims at assessing “seminal sparing” cystectomy results in our experience in the past 10 years with 213 patients-

Methods and results

In the past 10 years 213 patients underwent radical cystectomy: 165 males and 48 women. In 72 males radical cystectomy was combined with orthotopic neobladder substitution. Out of these patients, 12, all of which aged below 55, and affected by locally confined neoplasia, wished to preserve potency and continence after the operation. Accordingly, they had surgery involving “seminal sparing” cystectomy. From a technical perspective, surgery consists in an extensive limpho-adenectomy followed by a cystectomy preserving seminal vescicules, vasa deferentia and prostate capsula. Histology showed, in 8 cases (66%) recurring urothelial bladder carcinoma pT1HG, in 3 cases (25%) single lesions pT2HG, and in one case (8%) a leiomiosarcoma.

Discussion

The operation lasted 230 minutes (range 190-280). Average hospitalization was 13 days (range 8 to 22 days). The uretheral catheters were left in for an average of 12 days (10-16); in all cases the bladder catheter was removed on the 21st post op day. No significant intra, peri or post surgery complications were noted. Pathological staging confirmed the clinical one in all cases; only in relation to leiomiosarcoma, bilateral positivity of external iliac lymph-nodes was noted. Histological examinations of prostates showed a BPH in all cases. 10 patients are currently alive and in good general conditions bearing no evidence of recurring disease. All of them showed complete daytime continence at six months with normal uroflowmetry. All patients resumed sexual activity and was satisfactory for 10 (80%), while 2 patient (20%) were subject to Sildenafil therapy on demand. 2 patients retained partial antegrade ejaculation.

References

In selected cases the orthotopic ileal neobladder with sparing of the seminal carrefour is regarded as a viable technique in order to recreate and preserve sexual functions. Preservation of the vas deferens and of all prostatic glands allows complete retention of the erectile function and partially of the ejaculatory one.