Introduction

Prostate sparing cystectomy (PSC) is arguably a valid option for management of bladder cancer in selected cases. The majority of reported studies however have short term follow up as well as small sample size.We aimed to evaluate retrospectively our long term experience of prostate sparing cystectomy and compare it with our results of nerve sparing cystoprostatectomy (NSCP) in the laparoscopic/robotic era_x000D_

Methods

Between 2001 and 2011, 60 patients were treated with laparoscopic or robotic PSC for muscle invasive or recurrent non muscle invasive bladder cancer. These patients were matched and compared to 47 patients who received laparoscopic or robotic NSCP and orthotopic bladder substitution during the same study period. Regarding continence, surviving patients were postoperatively contacted, at 3 months and 1 year, to answer a questionnaire based on the International Continence Society guidelines for reporting continence after urinary diversion. Potency was accessed by a house made questionnaire addressing the use of any medications or devices to achieve erection.

Results

Mean patient age was 60.35 and 62.12 for PSC and NSCP respectively. Median follow up was 69.5 months and 62 months for PSC and NSCP respectively. Forty percent of PSC had ? pT1N0, 30% pT2N0, 22% ? pT3N0 while 8% had N+ disease; compared to NSCP patients whom 38% had ?pT1N0, 19% pT2N0, 23% ? pT3N0 and 19% N+. (p=0.74) The overall 3- and 5-year cancer specific survivals were 92% and 90% in the PSC group, and 82% and 79% in the NSCP group respectively. The local recurrence rates were 11.7 % and 21.3 % for the PSC and the NSCP groups respectively, and the respective distant recurrence rate was 17% and 28%._x000D_ Regarding continence; 45% in the PSC showed immediate and full recovery of continence day and night compared to no patient in the NSCP group. After 1 year, 97% and 71% of PSC group were completely leak-free for day and night respectively, compared to 78% and 37% in NSCP (p?0.001). The incidence of self catheterization was equal in both groups at 15%. On long term follow up, 42% of PSC patients developed symptoms secondary to outlet obstruction and 18% of them required endoscopic resection of their prostate. While in NSCP patients, 4% developed anastomotic stricture that required endoscopic fulgration ( p?0.001)_x000D_ Regarding potency; 49% of PSC and 23% of NSCP reported maintaining similar preoperative potency level. Sexual intercourse was achievable without any treatment in 68% of PSC compared to 37% in NSCP. The incidence of intracavernosal injection was higher in the NSCP arm compared to the PSC (41% vs.17%) Four patients (9%) in the NSCP group failed all conservative management and required penile prosthesis compared to no patient in the PSC group. ( p?0.001)_x000D_

Conclusions

Prostate sparing cystectomy is superior to nerve-sparing cystoprostatectomy regarding continence and potency. However, candidate patients who wish to retain their prostate should be informed about the long term need to manage outflow obstructive symptoms.

Funding

none