Abstract
BackgroundWe have proposed a modified, completely intrafascial radical cysprostatectomy (RC) to treat bladder cancer patients with the aim of preserving the patients’ post-surgical urinary control and erectile function. This study aimed to evaluate the oncological and functional outcomes of this innovation relatively to that with the conventional technique.MethodsA retrospective, single-center, blinded, and controlled study was conducted using the medical data of patients since the past 5 years from the hospital database. A total of 44 patients were included, including 20 who received complete intrafascial cysprostatectomy and 24 who received conventional interfascial surgeries. The patients’ continent and sexual information of 1-year follow-up after the surgery were extracted. The oncological and functional outcomes of the 2 groups were compared and analyzed.ResultsThe demographics parameters of the 2 groups showed no significant difference. The results of follow-up of the oncological outcomes did not reveal any significant difference between the completely intrafascial group and the conventional interfascial group in terms of the positive surgical margins, local recurrences, and distant metastasis. Patients following neobladder diversion in the intrafascial group showed a faster recovery of the urinary control, with a 76.9% (10/13) daytime continent rate at 3-month, as well as 46.2% (6/13) and 58.3% (7/12) nighttime continent rates at 3-month and 6-month, respectively. Regarding the sexual functions, our results revealed significant advantages in favor of completely intrafascial technique on the post-surgical International Index of Erectile Function (IIEF)-5 score at 3-, 9-, and 12-month follow-up relative to that with the conventional interfascial process. Thus, the IIEF score of patients in the intrafascial group was 11.4 ± 3.5 at 3-month, 14.1 ± 3.6 at 9-month, and 15.2 ± 3.8 at 12-month follow-up after the cystectomy, which was significantly greater than that of the patients in the control group.ConclusionsOur novel data illustrated that the modified completely intrafascial technique could result in a better sexual function and faster continence recovery for patients following RC, without any compromise in the cancer control. Thus, this technique could be considered as an alternative extirpative technique for bladder cancer treatment in a clinical setting.
Highlights
Radical cysprostatectomy (RC) is recommended as the standard treatment for muscle-invasive bladder cancer (MIBC) or refractory high risk non-MIBC (NMIBC) [1]
We sought to understand the differences in approaches to cancer control, voiding, and sexual function between these 2 patient populations in order to determine the potential of the proposed approaches as alternative extirpative techniques for bladder cancer treatment
We reviewed all the patient cases who received radical cysprostatectomy (RC) and, 44 patients were included in our analysis, of which 20 underwent the completely intrafascial surgery and 24 patients underwent the conventional interfascial surgery
Summary
Radical cysprostatectomy (RC) is recommended as the standard treatment for muscle-invasive bladder cancer (MIBC) or refractory high risk non-MIBC (NMIBC) [1]. This process has often been associated with significant morbidities, which may be bothersome and interfere with the quality of life (QoL) [2, 3]. We sought to understand the differences in approaches to cancer control, voiding, and sexual function between these 2 patient populations in order to determine the potential of the proposed approaches as alternative extirpative techniques for bladder cancer treatment. We have proposed a modified, completely intrafascial radical cysprostatectomy (RC) to treat bladder cancer patients with the aim of preserving the patients’ post-surgical urinary control and erectile function. This study aimed to evaluate the oncological and functional outcomes of this innovation relatively to that with the conventional technique
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