Long-term Functional and Oncologic Outcomes of nerve sparing and prostate capsule sparing cystectomy: a single center experience.

To evaluate technical feasibility, oncological and functional outcomes of nerve sparing cystoprostatectomy (NSCP) and prostate capsule sparing cystectomy (PCSC) for the treatment of organ confined bladder cancer at a single referral center.

From April 2001 to June 2012, 60 patients underwent PCSC, while 47 were treated with NSCP. Inclusion criteria for PCSC were: fully informed consent for the well-motivated patient; negative TUR of the bladder neck; normal PSA (defined as <4 ng/dL during the first year of the study, which was later lowered to 2.5 ng/dL); and normal TRUS, with biopsy for any suspicious nodule. Patients received a complete oncological and functional follow up. The Kaplan-Meier method was used to depict survival outcomes after surgery.

After a median follow up of 73 months and 62 months for PCSC and NSCP, the 5-year CSS was 90% for the PCSC group and 78% for the NSCP group, respectively (P = .055). Considering complications within 30 days after surgery, 13% and 21% patients suffered from Clavien III or higher complications in PCSC and NSCP groups, respectively (p=0.2). Considering functional outcomes, at 3 months after surgery, 54 (90%) and 24 (51%) patients reported full recovery of day time urinary continence in the PCSC and NSCP groups, respectively (p<0.001) and considering erectile function recovery, 32 (53%) and 4 (9%) patients in the PCSC group and in the NSCP group were respectively potent without any treatment (p<0.001).

NSCP and PCSC are appropriate indication for a subset of patients with bladder cancer with excellent oncological and functional results. These surgical procedures should be proposed to well-motivated patients. This article is protected by copyright. All rights reserved.

BJU international. 2019 Jun 20 [Epub ahead of print]

Mohamed Saad, Marco Moschini, Armando Stabile, Petr Macek, Camille Lanz, Dominique Prapotnich, Francois Rozet, Nathalie Cathala, Annick Mombet, Rafael Sanchez-Salas, Xavier Cathelineau

Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France.