V1859 NERVE-SPARING RADICAL CYSTECTOMY: AN ANTEGRADE ENDOPELVIC FASCIA-SPARING APPROACH

Abstract

INTRODUCTION AND OBJECTIVES: Several techniques have been proposed in an attempt to optimize the outcomes of radical cystectomy in terms of sexual and urinary functions. We report our refinement of antegrade open nerve-sparing radical cystectomy. METHODS: We describe nerve-sparing radical cystectomy utilizing an antegrade, endopelvic fascia sparing approach. After completion of bilateral extended lymphadenectomy, the superior and inferior vesical arteries are ligated and divided. The peritoneum overlying the seminal vesicles is divided in the cul de sac and the seminal vesicles are exposed. The tissues lateral to to the seminal vesicles are dissected, ligated and divided in an avascular plane leading to the base of the prostate. The endopelvic fascia is not incised and the prostatic capsule is released from the surrounding fascia preserving all the periprostatic tissues and nerves. Once the apex is reached the neuromuscular bundle can be clearly delineated and separated from the urethra. The urethra is then incised at the apex of the prostate under direct vision. RESULTS: This approach facilitates the preservation of the fascial attachments along the course of the neuromuscular bundles with minimal manipulation of the rhabdosphincter and the fascial attachments. CONCLUSIONS: The antegrade endopelvic fascia-sparing approach for radical cystectomy allows anatomic preservation of the fascial attachments along the course of the neuromuscular bundles and the striated sphincter. This may result in better sexual and urinary outcomes.