Prostate-sparing cystectomy: Potential functional advantages and objective oncological risks; a case series and review

OBJECTIVES: Prostate-sparing cystectomy (PSC) has been debated over the last decade; our aim was to assess the functional results and to evaluate the oncological outcome after PSC, to judge the value of this technique. PATIENTS AND METHODS: Twenty-six men (median age 62 years) who were candidates for radical cystectomy were operated between 2004 and 2009 in the urology departments of Foch Hospital, Suresnes, France, and Theodor Bilharz Research Institute, Giza, Egypt. They all underwent a PSC with orthotopic bladder substitution. The functional results were assessed at 1, 3 and 6 months, with the final results evaluated at 1 year. Incontinence was classified according to pads used per day, and erectile function after PSC was assessed using the International Index of Erectile Function questionnaire. There was a strict follow-up for oncological failure, with special attention given to the remnant of the prostate and prostatic urethra. RESULTS: The final functional results were assessed at 1 year, with daytime continence achieved in 22 patients (95%) and nocturnal leak in four (13%). At 1 year, 18 patients (83%) reported having erections on sexual stimulation. The median follow-up was 43 months, with an overall incidence of recurrence of 30% and a median time to metastasis of 30 months. At 36 months, the overall survival rate was 81%, with a tumour-free survival rate of 70%. CONCLUSION: PSC was no better than standard radical cystectomy, and should only be offered to patients who prefer preservation of their sexual function and continence over appropriate tumour control.