Potency preserving cystectomy with intrafascial prostatectomy for high risk superficial bladder cancer

We report the oncological and functional results of potency sparing cystectomy with intrafascial prostatectomy for high risk, superficial bladder cancer.

A total of 37 patients underwent potency sparing cystectomy and orthotopic urinary substitution from 2001 to 2005. Inclusion criteria were age younger than 70 years, Charlson comorbidity index less than 2, high risk superficial bladder cancer, prostate specific antigen less than 4 ng/ml, free-to-total PSA ratio greater than 20% and normal digital rectal examination.

Median patient age was 58 years (range 52 to 66). Median followup was 35 months (range 24 to 71). One patient died of disease progression and 1 died of an unrelated cause. Of the 37 patients 35 (95%) were free of tumor. Daily continence was achieved in 36 patients (97.2%) and nighttime continence was achieved in 35 (95%). Two patients (5%) needed clean intermittent catheterization. A total of 35 patients (95%) stated that they maintained erectile function, including 28 (76%) without oral drugs. A significant decrease in the median International Index of Erectile Function score from baseline was noted 2 years after surgery (25 vs 21). A total of 32 patients (86%) had an International Index of Erectile Function score of greater than 17 at 2 years after cystectomy. Median scores on the International Continence Society male short form questionnaires did not show any significant difference before and after surgery. Prostate specific antigen was lower than 0.2 ng/ml in all cases.

The main criticism about so-called sexuality sparing cystectomy has been the presence of consistent prostatic remnants. Performing intrafascial prostatectomy together with supra-ampullar cystectomy seems to warrant good functional results with while better preserving oncological safety.