Radical cystectomy with ultrasound-guided partial prostatectomy for bladder cancer: a complication-preventing concept

Radical cystectomy has been the reference standard for the treatment of muscle-invasive bladder cancer. However, this kind of therapy does have an impact on the patient's quality of life. For this reason, we performed prostate-sparing surgery during radical cystectomy without compromising the oncologic outcome.

From December 2003 to August 2005, 31 patients with a mean age of 63.6 +/- 8 years (range 48 to 79) underwent apex-sparing radical cystoprostatectomy for invasive bladder cancer. All patients underwent transurethral biopsy in the prostatic urethra to exclude urothelial tumor and transrectal ultrasound-guided biopsy of the prostate to diagnose concomitant prostate cancer. Patients with a prostate-specific antigen level greater than 4 ng/mL were excluded from prostate-sparing cystectomy. The mean follow-up period was 12 months.

The postoperative pathologic stage was pTis in 2 patients, pTa in 1, pT1 in 3, pT2 in 20, pT3 in 5, and pN+ in 4 patients. We found no prostate cancer on histopathologic evaluation. Except for 4 patients, no patient had deterioration of sexual function. Except for 2 patients, all patients were fully continent.

Radical cystectomy with prostate-sparing surgery in patients with invasive bladder cancer resulted in improved continence and improved erectile function. Additionally, with apex-sparing radical cystoprostatectomy, we were able to create a wide neovesicourethral anastomosis to prevent strictures, urinary retention, and mucous retention. It is absolutely necessary that this procedure be restricted to highly selected patients.