[Treatment of bladder cancer. Value of radical prostate-sparing cystectomy]

In the management of muscle-invasive bladder cancer, prostate-sparing cystectomy represents a surgical alternative to radical cystoprostatectomy with equivalent oncological and improved functional results. Patient selection for prostate-sparing cystectomy is very critical and men with pT1 high-grade or solitary pT2 urothelial cancer without multifocal CIS and bladder neck involvement appear to be the most appropriate candidates. Stromal invasion of the prostate and accompanying clinically significant prostate cancer must be ruled out by appropriate diagnostic maneuvers. Considering the above-mentioned selection criteria, local and systemic relapse rates are around 3 and 13%, respectively, and do not differ from radical cystoprostatectomy. Daytime and nighttime continence is around 90-95% and erectile function can be preserved in 80-90% of the patients. Therefore, the functional results are much better than those achieved for nerve-sparing radical cystoprostatectomy. Especially young men might benefit from prostate-sparing cystectomy.