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Fifteen-year single-centre experience with three different surgical procedures of nerve-sparing cystectomy in selected organ-confined bladder cancer patients

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Abstract

Objectives

To evaluate technical feasibility and oncologic and functional outcomes of three different surgical procedures of nerve-sparing radical cystectomy (NS-RC) for the treatment of organ-confined bladder cancer at a single referral centre.

Materials and methods

All consecutive cases of NS-RC carried out between 1997 and 2012 were retrospectively analysed. NS-RC included nerve-sparing cysto-vesicleprostatectomy (NS-CVP), capsule-sparing cystectomy (CS-C) and seminal-sparing cysto-prostatectomy (SS-CP). Peri-operative parameters and post-operative outcomes were analysed.

Results

Overall, 90 patients underwent NS-RC, 35 (38.9 %) of whom received a NS-CVP, while 36 (40 %) and 19 (21.1 %) underwent capsule CS-C and SS-CP, respectively. No difference was registered comparing oncologic outcomes of the three different techniques; however, two local recurrences after CS-C were attributed to the surgical technique. Complete post-operative daytime and night-time urinary continence (UC) at 24 and 48 months was achieved in 94.4 and 74.4 % and in 88.8 and 84.4 % of cases, respectively. CS-C showed both the best UC and sexual function preservation rate at early follow-up (24 months). Overall, a satisfactory post-operative erectile function (IIEF-5 ≥ 22) was proved in 57 (68.6 %) and 54 (65.0 %) patients at 24 and 48 months, respectively. Significant difference was found when comparing sexual function preservation rate of NS-CVP (28.5 %) to that of CS-C (91.6 %) and SS-CP (84.2 %).

Conclusion

NS-RC for male patients accounted for 7.4 % of overall radical cystectomy. To a limited extent of the selected organ-confined bladder cancers treated, the three different procedures analysed showed comparable results in terms of local recurrence and cancer-specific survival. Both CS-C and SS-CP procedures provided excellent functional outcomes when compared to original NS-CVP.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

All participants gave their informed consent to use their data for this retrospective study.

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Authors and Affiliations

  1. Departments of Urology, Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Hospital, San Raffaele Scientific Institute, Via Olgettina, 60-20132, Milan, Italy

    R. Colombo, M. Moschini, A. Gallina, R. Bertini, A. Salonia, P. Rigatti & F. Montorsi

  2. Department of Urology, Papa Giovanni XXIII Hospital, Bergamo, Italy

    F. Pellucchi

Authors
  1. R. Colombo
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  2. F. Pellucchi
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  3. M. Moschini
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  4. A. Gallina
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  5. R. Bertini
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  6. A. Salonia
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  7. P. Rigatti
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  8. F. Montorsi
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Correspondence to M. Moschini.

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Colombo, R., Pellucchi, F., Moschini, M. et al. Fifteen-year single-centre experience with three different surgical procedures of nerve-sparing cystectomy in selected organ-confined bladder cancer patients. World J Urol 33, 1389–1395 (2015). https://doi.org/10.1007/s00345-015-1482-y

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  • DOI: https://doi.org/10.1007/s00345-015-1482-y

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