[Impact of preservation of distal prostatic capsula and seminal vesicle on functions of orthotopic ideal neobladder and erectile function of bladder cancer patients]

Abstract

Background & objective: Radical cystectomy is the main treatment for invasive bladder cancer. Using ileal neobladder to reconstruct the low urinary tract is commonly applied as urine diversion in recent years. This study was to assess the impact of preservation of distal prostatic capsula and seminal vesicle during modified radical cystectomy on the functions of orthotopic ideal neobladder and erectile function of bladder cancer patients.

Methods: Clinical data of 36 bladder cancer patients, treated from Jan. 2000 to Dec. 2006, were analyzed. Of the 36 patients, 27 underwent modified cystectomy, and 9 underwent classical cystectomy. The distal prostatic capsula and seminal vesicle were retained in modified cystectomy group. The postoperative complications, functions of the neobladder (storage, continence, voiding) and erectile function of the 2 groups were evaluated and compared.

Results: The patients were followed up for 3 to 84 months. At 6 months after operation, the differences in the capacity of the neobladder [(385+/-68) mL vs. (388+/-71) mL] and maximal filling pressure [(24+/-16) cmH2O vs. (25+/-15) cmH2O] between modified cystectomy group and classical cystectomy group were not significant (P>0.05); while the differences in maximal urine flow rate (Qmax) [(18+/-5) mL/s vs. (14+/-7) mL/s], residual urine volume [(35+/-16) mL vs. (97+/-35) mL], the occurrence of complete urinary continence [(24/27) vs. (3/9)], nocturnal incontinence [(3/27) vs. (6/9)], anastomotic stenosis [(4/27) vs. (3/9)], and erectile function preservation [(19/23) vs. (3/7)] between the 2 groups were significant (P<0.05).

Conclusion: Preserving distal prostatic capsula and seminal vesicle can improve the continence and voiding functions of the orthotopic neobladder, preserve the erectile function, and prevent the occurrence of neovesicourethral anastomotic stenosis.