Nerve-sparing, robot-assisted radical cystectomy with intracorporeal bladder substitution in the male

To provide a step-by-step description of our technique of nerve and seminal-sparing robot-assisted radical cystectomy (nsRARC) with orthotopic neobladder and present the preliminary oncologic and functional outcomes.

The nsRARC with a modified Y-shaped orthotopic neobladder was performed in 40 men with clinically localized bladder cancer from January 2011 to September 2014 by the same surgeon. The operative, perioperative and pathologic data as well as continence and erectile function outcomes are presented.

Median follow-up was 26.5 months (8-52). One case of soft-tissue positive surgical margin was encountered in a patient with pT3a disease. A global rate of 30% of early and 32.5% of late complications was observed; however, the grade III (or higher) complication rate was low in both settings (2.5% and 5% respectively). There was one cancer-related death 23 months after surgery. 30/40 (75%) of the patients gained daytime continence (0 pad) within 1 month after surgery, while the 12 mo nocturnal continence rate was 72.5% (29/40 patients). Mean preoperative International Index of Erectile Function score-6 (IIEF-6) score was 24.4. 31/40 (77.5%) patients returned to normal erectile function (defined as IIEF-6>17) within 3 months while 29/40 (72.5%) patients returned to their preoperative IIEF-6 score within 12 months.

In the hands of an experienced surgeon, nsRARC with intracorporeal reconstruction of the neobladder seems feasible and safe. It provides short-term oncologic efficacy and promising functional outcomes. Yet, comparative, long-term follow-up studies with standard open cystectomy are required.

The Journal of urology. 2016 Jul 13 [Epub ahead of print]

Anastasios D Asimakopoulos, Adriano Campagna, Georgios Gakis, Victor Enrique Corona Montes, Thierry Piechaud, Jean-Luc Hoepffner, Camille Mugnier, Richard Gaston

Department of Urology, Clinique Saint-Augustin, Bordeaux, France. Electronic address: ., Department of Urology, Clinique Saint-Augustin, Bordeaux, France., Department of Urology, Clinique Saint-Augustin, Bordeaux, France., Department of Urology, Clinique Saint-Augustin, Bordeaux, France., Department of Urology, Clinique Saint-Augustin, Bordeaux, France., Department of Urology, Clinique Saint-Augustin, Bordeaux, France., Department of Urology, Clinique Saint-Augustin, Bordeaux, France., Department of Urology, Clinique Saint-Augustin, Bordeaux, France.

E-Newsletters

Newsletter subscription

Free Daily and Weekly newsletters offered by content of interest

The fields of GU Oncology and Urology are rapidly advancing. Sign up today for articles, videos, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.

Subscribe