To evaluate technical feasibility, oncological and functional outcomes of nerve sparing cystoprostatectomy (NSCP) and prostate capsule sparing cystectomy (PCSC) for the treatment of organ confined bladder cancer at a single referral center.
From April 2001 to June 2012, 60 patients underwent PCSC, while 47 were treated with NSCP. Inclusion criteria for PCSC were: fully informed consent for the well-motivated patient; negative TUR of the bladder neck; normal PSA (defined as <4 ng/dL during the first year of the study, which was later lowered to 2.5 ng/dL); and normal TRUS, with biopsy for any suspicious nodule. Patients received a complete oncological and functional follow up. The Kaplan-Meier method was used to depict survival outcomes after surgery.
After a median follow up of 73 months and 62 months for PCSC and NSCP, the 5-year CSS was 90% for the PCSC group and 78% for the NSCP group, respectively (P = .055). Considering complications within 30 days after surgery, 13% and 21% patients suffered from Clavien III or higher complications in PCSC and NSCP groups, respectively (p=0.2). Considering functional outcomes, at 3 months after surgery, 54 (90%) and 24 (51%) patients reported full recovery of day time urinary continence in the PCSC and NSCP groups, respectively (p<0.001) and considering erectile function recovery, 32 (53%) and 4 (9%) patients in the PCSC group and in the NSCP group were respectively potent without any treatment (p<0.001).
NSCP and PCSC are appropriate indication for a subset of patients with bladder cancer with excellent oncological and functional results. These surgical procedures should be proposed to well-motivated patients. This article is protected by copyright. All rights reserved.
BJU international. 2019 Jun 20 [Epub ahead of print]
Mohamed Saad, Marco Moschini, Armando Stabile, Petr Macek, Camille Lanz, Dominique Prapotnich, Francois Rozet, Nathalie Cathala, Annick Mombet, Rafael Sanchez-Salas, Xavier Cathelineau
Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France.