Long-term Outcomes of Prostate Capsule-Sparing and Nerve-Sparing Radical Cystectomy With Neobladder: A Propensity...

Area of Science:

• Urology
• Oncology
• Surgical Innovation

Background:

• Radical cystectomy is a standard treatment for muscle-invasive bladder cancer.
• Neobladder reconstruction is a common urinary diversion technique post-cystectomy.
• Evaluating surgical techniques like prostatic capsule-sparing (PCS) and nerve-sparing (NS) radical cystectomy is crucial for optimizing patient outcomes.

Purpose of the Study:

• To compare the feasibility and long-term efficacy of PCS versus NS radical cystectomy.
• To analyze oncological outcomes, functional results, and complication rates between PCS and NS groups.
• To assess the impact of these surgical approaches on urinary control and sexual function recovery.

Main Methods:

• Retrospective analysis of 145 patients undergoing radical cystectomy with neobladder reconstruction (June 2004 - December 2021).
• Patients divided into PCS (n=74) and NS (n=71) groups, with 1:1 propensity score matching applied.
• Kaplan-Meier analysis and log-rank tests used to compare oncological and survival outcomes.

Main Results:

• No significant differences in metastasis-free probability, cancer-specific survival, or overall survival between PCS and NS groups.
• PCS group demonstrated significantly higher rates of daytime urinary control at 3 months (72.9% vs 47.9%) and nocturnal urinary control at 3 and 6 months (54.2% vs 31.3%, 85.4% vs 60.4%).
• Significantly better erectile function recovery in the PCS group (62.5% vs 22.9%) compared to the NS group.

Conclusions:

• Prostatic capsule-sparing radical cystectomy is associated with superior urinary control and sexual function recovery compared to nerve-sparing radical cystectomy.
• Oncological outcomes remain comparable between the two surgical techniques.
• PCS may be associated with an increased risk of bladder-neck obstruction complications.