Continence and potency preserving cystoprostatectomy and substitution cystoplasty for patients with bladder cancer

Fifteen potent men with T3 M0 transitional cell carcinoma of the bladder underwent a technique for cystoprostatectomy designed to preserve the innervation of the distal sphincter mechanism and the corpora cavernosa, and substitution cystoplasty. All patients had previously had radiotherapy. When the neurovascular bundles were seen to be preserved all patients were continent by day (although one had objectively demonstrable stress incontinence) and 60% were potent. Damage to the neurovascular bundles was usually associated with impotence and a degree of stress incontinence, although the latter was correctable by implantation of an artificial sphincter. Cystectomy need not necessarily lead to an abdominal stoma or to impotence.