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Review
. 2025 Jan 1;17(1):110.
doi: 10.3390/cancers17010110.

Sexual-Sparing Radical Cystectomy in the Robot-Assisted Era: A Review on Functional and Oncological Outcomes

Carlo Introini  1 , Manfredi Bruno Sequi  2 , Marco Ennas  1 , Andrea Benelli  1 , Giovanni Guano  1 , Antonio Luigi Pastore  2 , Antonio Carbone  2
Affiliations
Review

Sexual-Sparing Radical Cystectomy in the Robot-Assisted Era: A Review on Functional and Oncological Outcomes

Carlo Introini et al. Cancers (Basel). .

Abstract

Background/Objectives: Radical cystectomy (RC) is the standard treatment for muscle-invasive and high-risk non-muscle-invasive bladder cancer, but it often results in significant functional impairments, including sexual and urinary dysfunction, adversely affecting quality of life (QoL). Sexual-sparing robotic-assisted radical cystectomy (RARC) has been introduced to mitigate these effects. This review evaluates the oncological and functional outcomes of sexual-sparing RARC in male and female patients. Methods: A systematic literature search identified 15 studies including 793 patients who underwent sexual-sparing RARC using techniques such as nerve-sparing, capsule-sparing, and pelvic organ-preserving approaches. Data on oncological and functional outcomes were analyzed. Results: Sexual-sparing RARC achieves oncological outcomes comparable to open RC, with negative surgical margin (NSM) rates exceeding 95% in most studies. RFS and CSS rates were robust, often surpassing 85% at intermediate follow-ups. Functional outcomes were also favorable, with continence rates exceeding 90% and erectile function recovery surpassing 70% in well-selected male patients. Female patients undergoing pelvic organ-preserving techniques demonstrated improved continence, preserved sexual function, and enhanced QoL. Patient selection emerged as critical, favoring those with organ-confined disease and good baseline function. Conclusions: Sexual-sparing RARC offers a promising balance between oncological control and functional preservation, making it an effective option for selected patients. Further research is needed to refine techniques and establish standardized protocols for broader adoption.

Keywords: bladder cancer; nerve-sparing; outcomes; radical cystectomy; robotic; sexual function; sexual-sparing; urinary function.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Graphical representation of continence outcomes [18,19,20,21,22,24,25,26,27,28,29,30,31,32].
Figure 2
Figure 2
Graphical representation of oncological outcomes [22,24,25,26,31].
See this image and copyright information in PMC

References

    1. Jubber I., Ong S., Bukavina L., Black P.C., Compérat E., Kamat A.M., Kiemeney L., Lawrentschuk N., Lerner S.P., Meeks J.J., et al. Epidemiology of Bladder Cancer in 2023: A Systematic Review of Risk Factors. Eur. Urol. 2023;84:176–190. doi: 10.1016/j.eururo.2023.03.029. - DOI - PubMed
    1. Golijanin D.J., Kakiashvili D., Madeb R.R., Messing E.M., Lerner S.P. Chemoprevention of bladder cancer. World J. Urol. 2006;24:445–472. doi: 10.1007/s00345-006-0123-x. - DOI - PubMed
    1. Cumberbatch M.G., Rota M., Catto J.W., La Vecchia C. The Role of Tobacco Smoke in Bladder and Kidney Carcinogenesis: A Comparison of Exposures and Meta-analysis of Incidence and Mortality Risks. Eur. Urol. 2016;70:458–466. doi: 10.1016/j.eururo.2015.06.042. - DOI - PubMed
    1. Witjes J.A., Bruins H.M., Carrión A., Cathomas R., Compérat E., Efstathiou J.A., Fietkau R., Gakis G., Lorch A., Martini A., et al. European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2023 Guidelines. Eur. Urol. 2024;85:17–31. doi: 10.1016/j.eururo.2023.08.016. - DOI - PubMed
    1. Choi H., Park J.Y., Bae J.H., Tae B.S. Health-related quality of life after radical cystectomy. Transl. Androl. Urol. 2020;9:2997–3006. doi: 10.21037/tau.2020.02.01. - DOI - PMC - PubMed

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