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Nerve- And Seminal-Sparing Cystectomy Effective in Patients with Bladder Cancer

Nerve and seminal sparing cystectomy (NSSC) seems to provide satisfactory outcomes in patients with superficial high risk or muscular invasive T2 bladder cancer, a new study suggests.

The standard technical procedure for radical cystectomy includes the en bloc removal of the bladder, prostate and seminal vesicles, and this often results in loss of potency and urinary continence.

Renzo Colombo, MD, with the Department of Urology, at the University Vita-Salute San Raffaele, Milan, Italy, and colleagues assessed postoperative clinical outcomes in patients treated with NSSC.

A total of 27 patients (mean age 52 years, range 36 to 61) with superficial high risk or muscular invasive T2 bladder cancer underwent radical NSSC with ileocapsule anastomosis.

Postoperative clinical outcomes were evaluated at 3, 6, and 12 months, and included voiding patterns, urinary continence, and urodynamic parameters. Overall sexual function was determined at baseline, 6, and 12 months.

Compared to standard cystoprostatectomy, NSSC provided better outcomes with regard to urinary and urodynamic parameters. Mean interval between micturitions throughout the day was 2.4 and 3.5hours, at 3 and 12-month follow up, respectively. In addition, 144% of patients were totally dry throughout the night without any awakening, while the remaining patients woke up 1 or 2 times per night to void the neobladder.

Moreover, postoperative erectile function and overall sexual quality of life were satisfactory at all timepoints measured during followup. Retrograde ejaculation with reliable sperm retrieval from urine was also documented.

"The nerve and seminal sparing cystectomy performed can ensure excellent clinical and functional outcomes," Dr. Colombo and colleagues conclude.

"As far as sexual function is concerned, there is no doubt about the excellent results of the nerve and seminal sparing technique. All patients reported normal erectile function as well as satisfactory sexual activity in the early and delayed follow-up after nerve- and seminal-sparing cystectomy," they add.

However, they point out that long-term follow up is important for establishing whether this surgical procedure is useful for young, fully potent patients with organ confined bladder cancer.

J Urol. 2004;171:1819-1822 "Overall Clinical Outcomes After Nerve and Seminal Sparing Radical Cystectomy for the Treatment of Organ Confined Bladder Cancer"

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