Total or partial prostate sparing cystectomy for invasive bladder cancer: long-term implications on erectile function

Area of Science:

• Urology
• Oncology
• Surgical Outcomes

Background:

• Radical cystectomy (RC) for invasive bladder carcinoma risks urinary incontinence and erectile dysfunction (ED), impacting quality of life.
• Prostate-sparing cystectomy (PSC) aims to mitigate these risks, particularly in younger patients.

Purpose of the Study:

• To evaluate long-term erectile function (EF) outcomes after partial prostate-sparing cystectomy (PASC) versus total prostate-sparing cystectomy (TPSC).
• To compare the efficacy of PASC and TPSC in preserving EF while maintaining cancer control.

Main Methods:

• A cohort of 21 men (mean age 56) underwent either PASC (15) or TPSC (6) between 2003-2005.
• Patients were assessed for self-reported EF and International Index of EF (IIEF) scores pre- and post-surgery.
• Mean follow-up was 30 months for PASC and 24 months for TPSC.

Main Results:

• The IIEF EF domain score was 20 for PASC (mild-moderate ED) and 30 for TPSC (normal EF).
• Cancer staging revealed understaging in 8/15 PASC cases and 2/6 TPSC cases, with significantly different results (P < 0.05).
• Recurrence rates were 1/15 for PASC and 1/6 for TPSC.

Conclusions:

• TPSC demonstrated superior EF preservation compared to PASC, with a 10-point higher IIEF score.
• Prostate-sparing cystectomy can significantly preserve EF in invasive bladder cancer patients.
• Appropriate patient selection for PSC can maintain oncological safety without compromising EF.