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Retzius-Sparing Robot-Assisted Radical Prostatectomy

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Prostate-sparing cystectomy: has Pandora's box been opened?

John C Kefer¹, Edward E Cherullo, J Stephen Jones

¹Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. keferj@ccf.org

Expert Review of Anticancer Therapy

|July 14, 2007

Summary

Prostate-sparing cystectomy (PSCx) may improve functional outcomes and timely acceptance of bladder cancer treatment. However, oncologic efficacy and standardized protocols for this controversial procedure remain undefined.

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Area of Science:

Urology
Oncology

Background:

Radical cystectomy traditionally includes en bloc prostate removal due to occult malignancy risk.
Prostate removal during cystectomy carries significant morbidity, potentially delaying treatment and worsening prognosis.

Purpose of the Study:

To evaluate the potential benefits and challenges of prostate-sparing cystectomy (PSCx).
To explore PSCx's impact on functional outcomes and patient acceptance in bladder cancer treatment.

Main Methods:

Review of recent investigations and series advocating for prostate-sparing cystectomy.
Analysis of reported functional results and potential for laparoscopic approaches.

Main Results:

PSCx series report excellent postoperative functional results, including improved continence and potency.

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PSCx may facilitate laparoscopic procedures, offering additional advantages.

Conclusions:

PSCx shows promise for enhancing functional recovery and patient compliance in bladder cancer management.
Significant concerns persist regarding the oncologic safety of PSCx, necessitating defined protocols for patient selection, technique, and surveillance.