Abstract
We believe that although prostate- and seminal-sparing cystectomy has been criticized by many investigators for the substantial risk of distant metastases greater than the rate observed after radical cystectomy, others suppose that standard radical cystoprostatectomy causes a dramatic negative effect on many aspects of quality of life. Consequently, radical surgery is often extremely delayed—especially in young patients—with consequent positive pelvic lymph nodes and undoubted negative outcome in terms of disease-free survival in a consistent number of patients. 1 Colombo R. Bertini R. Salonia A. et al. Overall clinical outcomes after nerve and seminal sparing radical cystectomy for the treatment of organ confined bladder cancer. J Urol. 2004; 171: 1819-1822 Abstract Full Text Full Text PDF PubMed Scopus (86) Google Scholar This might be of particular importance, especially that the age of patients in cases of squamous cell carcinoma associated with bilharziasis is usually relatively younger than that of transitional cell carcinoma of the bladder (in the present study, 71.2% of the patients were young or middle aged and hence might be looking forward to maintaining erectile function and having children). However, we believe that radicality is more important than planning fertility-sparing, or even potency-sparing, cystectomy that only improve the quality of life but could affect survival. Hence, the indications for prostate- and seminal-sparing cystectomy should include early-stage tumors at very low risk of metastasis. Editorial CommentUrologyVol. 78Issue 6PreviewSquamous cell carcinoma (SCC) of the urinary bladder, although uncommon in Europe and the United States, is the most common variety of bladder tumor in countries where urinary bilharziasis prevails.1 Radical cystoprostatectomy remains the main treatment, giving a 5-year survival rate of 50%.1 However, because of its effect on sexual function, urinary control, and body image, radical cystectomy is one of the most traumatic cancer operations. Currently, in young patients undergoing radical cystectomy and continent diversion, the primary sources of symptom-induced distress are related to sexual dysfunction (ie, decreased sexual potency, reduced sexual desire, reduced intercourse, and orgasm frequency). Full-Text PDF
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