Nerve-sparing Radical Cystectomy Research Articles

Long-term follow-up results of prostate capsule-sparing and nerve-sparing radical cystectomy with neobladder: a single-center retrospective analysis

ObjectiveThis study aims to investigate and analyze the feasibility, oncological outcomes, functional efficacy, and complications with the prostatic capsule sparing (PCS) as well as the nerve sparing (NS) in radical cystectomy for bladder cancer.Patients and methodsBetween January 2007 and December 2021, 67 total cystectomies with PCS and 54 with NS were performed at our institution. The inclusion criteria for PCS were as follows: proactive, fully informed patient consent; negative transurethral resection of the bladder neck; normal prostate-specific antigen (PSA) level < 4 ng/dL; and normal transrectal ultrasonography with biopsy of any suspicious nodes. Patients received complete oncological and functional follow-ups. The Kaplan-Meier method was utilized to characterize survival outcomes after surgery.ResultsThe median follow-up times for PCS and NS were 144 and 122 months, respectively. Cumulative survival estimated the 5- and 10-years cancer-specific survival were 93.0% and 88.7% for the PCS group and 79.7% and 79.6% for the NS group, respectively (p = 0.123). In terms of function, the daytime urinary control at 3, 6, and 12 months postoperatively was 80.60%, 97.01%, and 100% in the PCS group, and 53.70%, 85.19%, and 94.44% in the NS group, respectively (p = 0.002, 0.023, and 0.100); and nocturnal urinary control was 62.69%, 94.03%, and 98.51% in the PCS group, and 40.74%, 72.22%, and 87.04% in the NS group, respectively (p = 0.016, 0.001, and 0.022). The erectile function recovery revealed that 62.69% and 40.74% of patients returned to preoperative levels (International Index of Erectile Function (IIEF)-5 score ≥ 15) in the PCS and NS groups, respectively (p = 0.016). Considering complications within 30 days after surgery, 4.48% and 7.69% patients had Clavien ≥ III complications in the PCS and NS groups, respectively (p = 0.700).ConclusionThe PCS provides better restored urinary control and sexual function than the NS technique and does not affect oncological outcomes. However, PCS is prone to bladder-neck obstruction complications and requires closer long-term follow-up.

PJY16 - Bilateral nerve-sparing robotic-assisted radical cystectomy with Y-shape intracorporeal bladder: Perioperative and functional outcomes in a tertiary care center

PJY16 - Bilateral nerve-sparing robotic-assisted radical cystectomy with Y-shape intracorporeal bladder: Perioperative and functional outcomes in a tertiary care center

Urinary function in female patients after traditional, organ-sparing and nerve-sparing radical cystectomy for bladder cancer: a systematic review and pooled analysis.

To determine and summarize the available data on urinary, sexual, and health-related quality-of-life (HRQOL) outcomes after traditional radical cystectomy (RC), reproductive organ-preserving RC (ROPRC) and nerve-sparing RC (NSRC) for bladder cancer (BCa) in female patients. The PubMed, SCOPUS and Web of Science databases were searched to identify studies reporting functional outcomes in female patients undergoing RC and urinary diversion for the treatment of BCa. The outcomes of interest were voiding function (for orthotopic neobladder [ONB]), sexual function and HRQOL. The following independent variables were derived and included in the meta-analysis: pooled rate of daytime and nighttime continence/incontinence, and intermittent self-catheterization (ISC) rates. Analyses were performed separately for traditional, organ- and/or nerve-sparing surgical approaches. Fifty-three studies comprising 2740 female patients (1201 traditional RC and 1539 organ-/nerve-sparing RC, and 264 nerve-sparing-alone RC) were eligible for qualitative synthesis; 44 studies comprising 2418 female patients were included in the quantitative synthesis. In women with ONB diversion, the pooled rates of daytime continence after traditional RC, ROPRC and NSRC were 75.2%, 79.3% and 71.2%, respectively. The pooled rate of nighttime continence after traditional RC was 59.5%; this rate increased to 70.7% and 71.7% in women who underwent ROPRC and NSRC, respectively. The pooled rate of ISC after traditional RC with ONB diversion in female patients was 27.6% and decreased to 20.6% and 16.8% in patients undergoing ROPRC and NSRC, respectively. The use of different definitions and questionnaires in the assessment of postoperative sexual and HRQOL outcomes did not allow a systematic comparison. Female organ- and nerve-sparing surgical approaches during RC seem to result in improved voiding function. There is a significant need for well-designed studies exploring sexual and HRQOL outcomes to establish evidence-based management strategies to support a shared decision-making process tailored towards patient expectations and satisfaction. Understanding expected functional, sexual and quality-of-life outcomes is necessary to allow individualized pre- and postoperative counselling and care delivery in female patients planned to undergo RC.

Practice Patterns Regarding Female Reproductive Organ-Sparing and Nerve-Sparing Radical Cystectomy Among Urologic Oncologists in the United States.

Female reproductive organ-sparing (ROS) and nerve-sparing radical cystectomy (RC) techniques have been shown to be oncologically safe and to improve sexual function outcomes among select patients with organ-confined disease. We sought to characterize practice patterns regarding female ROS and nerve-sparing RC among US urologists. We conducted a cross-sectional survey of members of the Society of Urologic Oncology to assess provider-reported frequency of ROS and nerve-sparing RC in premenopausal and postmenopausal patients with non-muscle-invasive bladder cancer that failed intravesical therapy or clinically localized muscle-invasive bladder cancer. Among 101 urologists, 80 (79.2%) reported that they routinely resect the uterus/cervix, 68 (67.3%) the neurovascular bundle, 49 (48.5%) the ovaries, and 19 (18.8%) a portion of the vagina when performing RC in premenopausal patients with organ-confined disease. When asked about changes to approach in postmenopausal patients, 71 participants (70.3%) reported that they were less likely to spare the uterus/cervix, 44 (43.6%) were less likely to spare the neurovascular bundle, 70 (69.3%) were less likely to spare the ovaries, and 23 (22.8%) were less likely to spare a portion of the vagina. We identified significant gaps in adoption of female ROS and nerve-sparing RC techniques for patients with organ-confined disease, despite evidence that ROS and nerve-sparing techniques are oncologically safe and can optimize functional outcomes in select patients. Future efforts should improve provider training in and education about ROS and nerve-sparing RC to improve postoperative outcomes among female patients.

Functional outcomes in female patients after traditional, organ- and nerve-sparing radical cystectomy and urinary diversion for bladder cancer: A systematic review and pooled analyses

Functional outcomes in female patients after traditional, organ- and nerve-sparing radical cystectomy and urinary diversion for bladder cancer: A systematic review and pooled analyses

Case - Salvage nerve-sparing radical cystectomy for pediatric rhabdomyosarcoma of the bladder.

Case - Salvage nerve-sparing radical cystectomy for pediatric rhabdomyosarcoma of the bladder.

Perioperative and Pathological Outcome of Nerve-Sparing Radical Cystectomy With Ileal Neobladder.

Purpose: So far, it has not been described whether the perioperative course and the pathologic outcome of patients who undergo radical cystectomy (RC) with orthotopic bladder substitution differs if nerve sparing (NS) is performed or not.Material and Methods: In all, there were 472 patients who underwent RC between 2012 and 2019 at our department. We performed a retrospective analysis of 116 patients who underwent RC with ileal neobladder. We analyzed perioperative complications according to the Clavien–Dindo classification system, as well as the pathological outcome.Results: Of 116 patients, 68 (58.6%) underwent RC, and 48 (41.4%) underwent NS RC. Clavien–Dindo complications ≥3b occurred in 15 (12.9%) of all patients. Only infectious complications differed among the groups [NS RC: 25 patients (52.1%) vs. RC: 20 patients (29.4%); p = 0.02]. There was no significant difference concerning tumor stage. Concomitant Cis was present in 24 patients (35.3%) of the RC group and in 27 patients (56.3%) of the NS RC group (p = 0.036). Nodal status and positive surgical margin status of the bladder tumor did not differ among the groups. In all, 42 of all male patients (45.7%) had an incidental prostatic carcinoma. Positive surgical margins concerning the prostate carcinoma occurred in six patients, with all cases in the RC group (p = 0.029).Conclusions: Our data suggest that performing NS during RC in carefully selected patients is a safe procedure and does not impair perioperative outcome. Pathological outcome of NS RC is comparable as well.

Histologic Investigation of the Female Vesicourethral Junction and Adjacent Tissues for Nerve-sparing Radical Cystectomy

ObjectiveTo understand the structures around the vesicourethral junction and to improve functional outcomes after nerve-sparing radical cystectomy with orthotopic urinary diversion for female patients, we histologically elucidated the fibromuscular construction and nerve distribution around the vesicourethral junction. MethodsPelvic specimens containing all the pelvic viscera were obtained from 33 donated female cadavers. Macroslices that included the urethra, the anterior wall of the vagina, and the inferomedial edge of the levator ani muscle were made and performed elastica Masson and immunohistochemical staining. The intraoperative findings were collected in 3 female patients undergoing nerve-sparing radical cystectomy. ResultsIn 18 out of the 33 cadavers, smooth muscle mass occupied a space between the urethra and the inferomedial edge of the levator ani muscle and covered the inferior margin of the bladder detrusor. We termed this mass the hiatal smooth muscle. The detrusor nerves entered the bladder, and the cavernous and sphincter nerves ran between the hiatal smooth muscle and vesicourethral junction. The boundary between hiatal smooth muscle and urethral smooth muscle was easily distinguished intraoperatively during dissection of the vesicourethral junction. ConclusionWe found that more than half of elderly women have hiatal smooth muscle between the urethra and inferior edge of the levator ani. Autonomic nerve fibers innervating the urethral sphincter, run between the hiatal smooth muscle and vesicourethral junction in female cadavers with hiatal smooth muscle. When performing female radical cystectomy before neobladder reconstruction, nerve sparing can be reliably performed using the hiatal smooth muscle as a landmark.

Effect of neurovascular bundle sparing radical cystectomy on post‐operative continence and sexual function: A systematic review and meta‐analysis

It is unclear whether the neurovascular bundle (NVB) sparing could improve post-operative urinary continence and potency. Furthermore, concern remains regarding the impact of nerve-sparing (NS) radical cystectomy (RC) on oncological outcomes. The primary objective of this meta-analysis was to evaluate whether in men undergoing NS RC could improve post-operative urinary continence and potency. The secondary objective was to assess whether NS RC could compromise the oncological control. A systematic search of the PubMed and Web of Science was performed in February 2020, yielding 1446 unique records. A total of 13 comparative cohort studies were included. Risk of bias in each study was assessed separately by two authors using the Newcastle-Ottawa Scale (NOS). Data from 921 participants in 12 studies were synthesized in the present meta-analysis. Meta-analysis revealed that NS compared with non-nerve sparing (NNS) results in improved post-operative potency, daytime continence, and nocturnal continence. RRs were 9.35 (P<.00001) in potency, 1.11 (P=.045) in daytime continence, and 1.33 (P=.002) in nocturnal continence, respectively. Furthermore, no differences were found in the included studies reporting oncological outcomes. RRs were 0.88 (P=.61) in local and/or distant recurrence between two groups. A sensitivity analysis of prospective studies indicated consistent results. This meta-analysis indicates that NS RC can improve post-operative potency, and daytime and nocturnal urinary continence, without compromising oncological control, compared with NNS RC in men.

PD41-02 SHORT SEGMENT ILEAL ORTHOTOPIC NEOBLADDER FOLLOWING RADICAL CYSTECTOMY FOR BLADDER CANCER: DOES SIZE MATTER?

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (PD41)1 Apr 2020PD41-02 SHORT SEGMENT ILEAL ORTHOTOPIC NEOBLADDER FOLLOWING RADICAL CYSTECTOMY FOR BLADDER CANCER: DOES SIZE MATTER? Anthony Devasia*, Arun George, Ramani Kumar, and Chandra Singh Anthony Devasia*Anthony Devasia* More articles by this author , Arun GeorgeArun George More articles by this author , Ramani KumarRamani Kumar More articles by this author , and Chandra SinghChandra Singh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000921.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Orthotopic neobladder is a diversion that is increasingly used following cystectomy for bladder cancer. The standard length of ileum used is 60 cm. We evaluated the functional outcomes of a short segment (35+5cm) ileal neobladder. METHODS: Following at least one side nerve sparing radical cystectomy for bladder cancer, orthotopic ileal neobladder was constructed using 35 cm of ileum for the pouch with an additional 5cm chimney. Preoperatively all patients were taught pelvic floor excercises and advised to perform them several times a day while awaiting surgery. Postoperatively frequent voiding was advised with alarm regulated voids at night keeping the voided volume to <400ml.Data was retrieved from our electronic database. Pouch capacity, voiding, continence, erectile function, upper tracts and biochemistry were assessed RESULTS: Of a total of 39 males who underwent the procedure from 2003 to 2019, an N pouch was constructed in 34. The mean age was 50.7 (SD 10.5)years and the mean follow up was 54 months. At 1 month, continence was 59% and at 3 months, 82.4% were fully continent with occasional nocturnal leak. By 6 months, all were continent not requiring pads with a rare leak of a few drops in a few, only at night. All men voided spontaneously without the need for clean catheterisation with a mean Q max of 22 ml/sec (SD 12), voided volume of 273ml (SD 109) and a residue of 30 ml(SD 23). There was no metabolic abnormality and renal function remained stable in all with no upper tract dilatation. Spontaneous erections were seen in 44% and 17% required PDE5 inhibitors. Six received chemotherapy (neoadjuvant 5, adjuvant 1). Two, in their late sixties who were fully continent for several years developed mild worsening of continence that improved after restarting pelvic floor exercises. Five years post operatively, one developed a calculus on the suture at the urethral anastomosis causing a ball valve effect, resulting in poor flow. The flow was restored after removal of the calculus. Thirty three (84.6%)were tumor free at the last review and 6 expired with late recurrence and metastases CONCLUSIONS: Orthotopic neobladder with a short segment of ileum (35+5) had good outcomes in terms of voiding to completion, continence and capacity, with biochemical and upper tract preservation in a carefully selected group. Source of Funding: nil © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e821-e821 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anthony Devasia* More articles by this author Arun George More articles by this author Ramani Kumar More articles by this author Chandra Singh More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparing Provider-Led Sexual Health Counseling of Male and Female Patients Undergoing Radical Cystectomy

BackgroundSexual dysfunction is a common quality-of-life issue among patients undergoing radical cystectomy (RC) for bladder cancer, but patients report deficiencies in sexual health counseling. AimWe sought to characterize provider-led sexual health counseling of patients undergoing RC and whether provider practice differs by patient gender. MethodsWe conducted a cross-sectional survey of members of the Society of Urologic Oncology to assess topics included in provider-led sexual health counseling and barriers to counseling. OutcomesNonroutine counseling regarding each sexual health topic was compared for female vs male patients using chi-squared tests. Modified Poisson regression was used to examine associations between provider characteristics and nonroutine counseling of female patients. ResultsAmong 140 urologists, the majority did not routinely counsel patients about sexual orientation, partner sexual dysfunction, or referral options to sexual health services. Providers were significantly more likely to not provide routine counseling to female patients compared to male patients about the following topics: baseline sexual activity (20.6% vs 9.7%, respectively, P = 0.04), baseline sexual dysfunction (60.8% vs 20.2%, respectively, P < 0.05), the risk of sexual dysfunction after RC (20.0% vs 6.5%, respectively, P = 0.006), the potential for nerve-sparing RC (70.8% vs 35.5%, respectively, P = 0.002), and postoperative sexual health and dysfunction (42.6% vs 21.1%, respectively, P = 0.01). Overall, 41.2% of providers did not routinely discuss the potential for pelvic organ-preserving RC with sexually active female patients. Provider sex, age, practice type, urologic oncology fellowship training, years in practice, or female RC volume were not predictive of nonroutine or disparate counseling of female patients. The most common barriers to counseling female patients were older patient age (50.7%), inadequate time (47.1%), and uncertainty about baseline sexual function (37.1%). Clinical ImplicationsUrologists acknowledge key deficiencies and gender disparities in sexual health counseling of patients undergoing RC. Strengths and LimitationsAlthough cross-sectional, to our knowledge, this is the first study to examine provider practice patterns regarding sexual health counseling of patients undergoing RC. ConclusionFuture efforts should be directed towards reducing barriers to sexual health counseling of patients undergoing RC to improve deficiencies and gender disparities.Gupta N, Kucirka LM, Semerjian A, et al. Comparing Provider-Led Sexual Health Counseling of Male and Female Patients Undergoing Radical Cystectomy. J Sex Med 2020;17:949–956.

V25 - Nerve-sparing robot-assisted radical cystectomy (RARC) with totally intracorporeal modified Vescica Ileale Padovana (VIP): Technical nuances and preliminary results

V25 - Nerve-sparing robot-assisted radical cystectomy (RARC) with totally intracorporeal modified Vescica Ileale Padovana (VIP): Technical nuances and preliminary results

Health related quality of life after urinary diversion. Which technique is better?

ObjectiveTo compare quality of life (QoL) after urinary diversion (UD) following radical cystectomy (RC) using validated questionnaires. Patients and methodsBetween January 2011 and June 2016, 150 patients (121 men [80.7%] and 29 women [19.3%]) with invasive bladder cancer who underwent RC and UD were included in this prospective study. Patients were divided into 2 groups; group I included the orthotopic neobladder 50 (33.3%) and uretro-sigmoidostomy 41 (27.3%) and group II included uretero-cutanoustomy 33 (22.1%) and ileal conduit 26 (17.3%) patients. QOL was evaluated using the Functional Assessment of Cancer Therapy–Bladder Cancer. The erectile function (EF) was assessed using the Sexual Health Inventory for Men Questionnaire. Evaluation was done before and after one year postoperatively. ResultsThe mean ± SD patient age was 55.0 ± 7.9 and 59.5 ± 8.5 years in both groups, respectively (p = 0.001). There was a significant difference in the physical, social/family, emotional and functional statuses that were significantly higher in group I. One year postoperatively, the emotional well-being became insignificantly different, but other QoL parameters remained significantly different between both groups. Regarding EF, there was a significant difference between patients who underwent nerve-sparing (No. 29) and non nerve-sparing RC (No. 59) (p < 0.001). ConclusionsWhich type of diversion is the best is still a controversial topic. Egyptian patients may prefer the continent UD to avoid the urostomy appliance and its associated daily-life constraints. Detailed patient counseling and active participation of the patient in selecting the treatment methods are important for better postoperative QoL.

Erectile Function and Long-term Oncologic Outcomes of Nerve-Sparing Robot-Assisted Radical Cystectomy: Comparison With Open Radical Cystectomy

Erectile Function and Long-term Oncologic Outcomes of Nerve-Sparing Robot-Assisted Radical Cystectomy: Comparison With Open Radical Cystectomy

Nerve-sparing radical cystectomy has a beneficial impact on urinary continence after orthotopic bladder substitution, which becomes even more apparent over time.

To analyse urinary continence in long-term survivors after radical cystectomy (RC) and orthotopic bladder substitution (OBS) according to attempted nerve-sparing (NS) status. We analysed 180 consecutive patients treated at our department between 1985 and 2007, who underwent RC with OBS, and survived ≥10 years after RC. We stratified patients by attempted NS status and evaluated continence outcomes using descriptive statistics and Cox proportional hazards regression models. A secondary analysis evaluated erectile function as a quality control for attempted NS. The median (interquartile range [IQR]) age at RC was 62 (57-71) years. Of 180 patients, attempted NS status was none in 24 (13%), unilateral in 100 (56%), and bilateral in 56 (31%). After a median (IQR) follow-up of 169 (147-210) months, 160 (89%) patients were continent during daytime and 124 (69%) during night-time. In multivariable analysis, any degree of attempted NS was significantly associated with daytime continence (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.05-4.11; P = 0.04). Correspondingly, any attempted NS was significantly associated with night-time continence (OR 2.51, 95% CI 1.08-5.85; P = 0.03). Recovery of erectile function at 5 years was also significantly associated with attempted NS (P < 0.001). Nerve-sparing during RC and OBS was associated with better long-term continence outcomes. This becomes more apparent as the patients age with their OBS. We advocate a NS RC whenever an OBS is considered.

PD02-04 HOSPITAL BUT NOT SURGICAL VOLUME PREDICTS 30- AND 90-DAY COMPLICATIONS IN RADICAL CYSTECTOMY (RC) – RESULTS FROM THE PROSPECTIVE MULTICENTER RADICAL CYSTECTOMY SERIES (PROMETRICS 2011) STUDY GROUP

PD02-04 HOSPITAL BUT NOT SURGICAL VOLUME PREDICTS 30- AND 90-DAY COMPLICATIONS IN RADICAL CYSTECTOMY (RC) – RESULTS FROM THE PROSPECTIVE MULTICENTER RADICAL CYSTECTOMY SERIES (PROMETRICS 2011) STUDY GROUP

Fifteen-year single-centre experience with three different surgical procedures of nerve-sparing cystectomy in selected organ-confined bladder cancer patients

To evaluate technical feasibility and oncologic and functional outcomes of three different surgical procedures of nerve-sparing radical cystectomy (NS-RC) for the treatment of organ-confined bladder cancer at a single referral centre. All consecutive cases of NS-RC carried out between 1997 and 2012 were retrospectively analysed. NS-RC included nerve-sparing cysto-vesicleprostatectomy (NS-CVP), capsule-sparing cystectomy (CS-C) and seminal-sparing cysto-prostatectomy (SS-CP). Peri-operative parameters and post-operative outcomes were analysed. Overall, 90 patients underwent NS-RC, 35 (38.9 %) of whom received a NS-CVP, while 36 (40 %) and 19 (21.1 %) underwent capsule CS-C and SS-CP, respectively. No difference was registered comparing oncologic outcomes of the three different techniques; however, two local recurrences after CS-C were attributed to the surgical technique. Complete post-operative daytime and night-time urinary continence (UC) at 24 and 48 months was achieved in 94.4 and 74.4 % and in 88.8 and 84.4 % of cases, respectively. CS-C showed both the best UC and sexual function preservation rate at early follow-up (24 months). Overall, a satisfactory post-operative erectile function (IIEF-5 ≥ 22) was proved in 57 (68.6 %) and 54 (65.0 %) patients at 24 and 48 months, respectively. Significant difference was found when comparing sexual function preservation rate of NS-CVP (28.5 %) to that of CS-C (91.6 %) and SS-CP (84.2 %). NS-RC for male patients accounted for 7.4 % of overall radical cystectomy. To a limited extent of the selected organ-confined bladder cancers treated, the three different procedures analysed showed comparable results in terms of local recurrence and cancer-specific survival. Both CS-C and SS-CP procedures provided excellent functional outcomes when compared to original NS-CVP.

Sparing radical cystectomy - How much is enough?

Radical cystectomy in females is increasingly being followed by orthotopic urinary diversion. This is particularly true when it comes to young patients. Wisahi et al. [1] from Egypt describe a small series of such patients with Bilharziosis associated bladder cancer. The results presented match well with those presented in other series [2–4]. Nerve-sparing radical cystectomy has been shown to be the most important determinant for subsequent neobladder function and sexual quality of life. Preservation of the uterus as proposed herein allows for very extensive nerve sparing. Moreover, dorsal stability is provided for the neobladder, which is also considered helpful in preventing obstruction. However, even with this approach still 3 women require CIC in this group. One may argue that other unknown factors could also be influential. Neobladder type itself does not appear as important as the actual radical cystectomy. Several groups have shown this before [2–4]. More importantly the authors have shown excellent sexual function. In very young women even pregnancy may be feasible. Leaving the uterus behind nevertheless is a risk factor for any later instrumentation to the internal genitalia. Injury to the neobladder is inadvertent if no urologist is part of the surgery team in such cases [5]. Overall survival was excellent in this group of women with two-thirds of them living more than 10 years. Aggressive early surgery may thus be warranted even in very young women affected by invasive bladder cancer. In developing countries such as Egypt or India clinicians are frequently challenged with young bladder cancer patients requiring radical cystectomy. The article published in this issue of the journal is particularly relevant to them.

Robotic Radical Cystectomy—Is the Diversion the Achilles' Heel?

No AccessJournal of UrologyOpposing Views1 Dec 2014Robotic Radical Cystectomy—Is the Diversion the Achilles' Heel? Richard E. Hautmann, Harry W. Herr, Raj S. Pruthi, and Monish Aron Richard E. HautmannRichard E. Hautmann More articles by this author , Harry W. HerrHarry W. Herr More articles by this author , Raj S. PruthiRaj S. Pruthi More articles by this author , and Monish AronMonish Aron More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.09.042AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail References 1 : Propensity-matched comparison of morbidity and costs of open and robot-assisted radical cystectomies: a contemporary population-based analysis in the United States. Eur Urol2014; . Epub ahead of print. Google Scholar 2 : A randomized trial of robot-assisted laparoscopic radical cystectomy. New Engl J Med2014; 371: 389. Google Scholar 3 : Selection of intestinal segments for bladder substitution: physical and physiological characteristics. J Urol1988; 139: 519. Link, Google Scholar 4 : Surgery in motion: robotic-assisted laparoscopic intracorporeal urinary diversion. Eur Urol2010; 57: 1013. Google Scholar 5 : Robot-assisted nerve-sparing radical cystectomy with bilateral extended pelvic lymph node dissection (PLND) and intracorporeal urinary diversion for bladder cancer: initial experience in 27 cases. BJU Int2011; 110: 434. Google Scholar 6 : Oncologic, functional, and complications outcomes of robotic-assisted radical cystectomy with totally intracorporeal neobladder diversion. Eur Urol2013; 64: 734. Google Scholar 7 : Laparoscopic-assisted radical cystectomy with U-shaped orthotopic ileal neobladder constructed using nonabsorbable titanium staples. Urology2006; 68: 193. Google Scholar 8 : The ileal neobladder: experience and results of more than 100 consecutive cases. J Urol1990; 143: 492. Abstract, Google Scholar 9 : Orthotopic bladder substitution in men. revisited: identification of continence predictors. J Urol2006; 176: 2081. Link, Google Scholar 10 : Robotic intracorporeal orthotopic ileal neobladder: replicating open surgical principles. Eur Urol2012; 62: 891. Google Scholar 11 : Nerve-sparing robot-assisted radical cystoprostatectomy and urinary diversion. BJU Int2003; 92: 232. Google Scholar 12 : Prospective randomized controlled trial of robotic versus open radical cystectomy for bladder cancer: perioperative and pathologic results. Eur Urol2010; 57: 196. Google Scholar 13 : Perioperative outcomes and oncologic efficacy from a pilot prospective randomized clinical trial of open versus robotic assisted radical cystectomy. J Urol2013; 189: 474. Link, Google Scholar 14 : Robotic intracorporeal urinary diversion: ileal conduit. J Endourol2012; 26: 1566. Google Scholar 15 : The first 100 consecutive, robot-assisted, intracorporeal ileal conduits: evolution of technique and 90-day outcomes. Eur Urol2013; 63: 637. Google Scholar 16 : Robotic intracorporeal orthotopic neobladder during radical cystectomy in 132 patients. J Urol2014; 192: 1734. Link, Google Scholar 17 : Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol2014; 65: 340. Google Scholar © 2014 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byHautmann R (2017) Declining Use of Orthotopic Reconstruction Worldwide—What Went Wrong?Journal of Urology, VOL. 199, NO. 4, (900-903), Online publication date: 1-Apr-2018.Hautmann R (2016) Editorial CommentJournal of Urology, VOL. 196, NO. 5, (1556-1557), Online publication date: 1-Nov-2016. Volume 192Issue 6December 2014Page: 1601-1603 Advertisement Copyright & Permissions© 2014 by American Urological Association Education and Research, Inc.MetricsAuthor Information Richard E. Hautmann More articles by this author Harry W. Herr More articles by this author Raj S. Pruthi More articles by this author Monish Aron More articles by this author Expand All Advertisement PDF downloadLoading ...

Prostate Capsule Sparing versus Nerve Sparing Radical Cystectomy for Bladder Cancer: Results of a Randomized, Controlled Trial

Prostate capsule sparing and nerve sparing cystectomies are alternative procedures for bladder cancer that may decrease morbidity while achieving cancer control. However, to our knowledge the comparative effectiveness of these approaches has not been established. We evaluated functional and oncologic outcomes in patients undergoing these procedures. We performed a single institution trial in patients with bladder cancer in whom transurethral prostatic urethral biopsy and transrectal prostate biopsy were negative. Men were randomized to prostate capsule sparing or nerve sparing cystectomy with neobladder creation and stratified by Sexual Health Inventory for Men score (greater than 21 vs 21 or less). Our primary end point was 12-month overall urinary function as measured by Bladder Cancer Index. Secondary end points included sexual function, cancer control and complications. A total of 40 patients were enrolled in the study with 20 patients in each arm. Urinary function at 12 months decreased by 13 and 28 points in the prostate capsule and nerve sparing groups, respectively (p = 0.10). Sexual function followed a similar pattern (p = 0.06). There was no difference in recurrence-free, metastasis-free or overall survival (each p >0.05). The rate of incidentally detected prostate cancer was similar (p = 0.15). Our study provides a randomized comparison of prostate capsule sparing and nerve sparing cystectomy techniques. We found no difference in functional or oncologic outcomes between the 2 approaches, although our study was underpowered due to a lack of patient accrual.