Organ-sparing robotic-assisted radical cystectomy in men: description of technique and outcomes

Organ sparing radical cystoprostatectomy in males is being considered with skepticism due to fear of compromising oncological safety; however, sacrifice of erectile nerves can lead to quality of life deterioration due to erectile dysfunction.

Data from men with muscle-invasive bladder cancer (MIBC) who were potent and wish to preserve potency were collected prospectively. Both nerve-sparing and capsule-sparing approach (with or without seminal vesicle preservation) was performed in a high-volume center. Baseline characteristics, oncological and sexual outcomes were collected. International Index for Erectile Function-5 (IIEF-5) was used both preoperatively and at last follow-up. Potency was defined as a score ≥3 in question 2.

Twenty-five patients were included in capsule-sparing and 15 in nerve-sparing group. Patients in the former group were younger (55 vs. 66 years old) but no other significant difference in baseline characteristics was noted. Perioperative outcomes were similar among groups, whilst no difference was found regarding overall survival, recurrence rate, incidental prostate cancer and positive surgical margins. Postoperative IIEF-5 score was higher in capsule-sparing group (14 vs. 7, P=0.016) and more patients were potent (18 vs. 3, P=0.004). In regression analysis, the only significant predictor of potency was capsule-sparing surgery (odds ratio: 8.58, 95% CI: 1.30-81.5, P=0.034).

Capsule-sparing and nerve-sparing approaches during robotic radical cystectomy are feasible techniques among carefully selected patients, with improved sexual and non-inferior oncological outcomes compared with standard approach.