Arroyo C, Andrews H, Rozet F, Cathelineau X, Vallancien G

Language: Spanish
References: 15
Page: 149-156
PDF size: 148.86 Kb.

ABSTRACT

Prostate sparing radical cystectomy has been described in the literature and has proven to be a promising procedure because of the continence and erectile function results without necessarily compromising the oncologic outcome in selected patients. Objective. We report our preliminary results of this technique performed laparoscopically. Technique. Through a transperitoneal approach, lymph node dissection is done with frozen section, then the ureters are ligated and biopsied. The seminal vesicles are dissected, followed by complete mobilization of the bladder; next is the incision on the bladder neck followed by the bladder pedicule section. A simple prostatectomy can be performed if needed. Finally, the bowel reconstruction is done via a small infraumbilical incision that also permits the extraction of the surgical specimen and the anastomosis of neobladder to the prostate capsule. Patients. A total of 25 patients with an average age of 60, have undergone this procedure, with average surgical times of 285 minutes and blood loss of 640 mL. The complications encountered were: 1 bowel incarceration, 1 urinary leak, 1 lymphocele and 1 port hernia. All of the patients are alive at 9 month follow-u, except for one who died because of cancer progression. No patient presented with daytime incontinence, and there were 7 that referred nicturia. There were 20 patients that maintained their preoperative sexual potency, and 4 that referred a decrease in their erectile function postoperatively. Conclusions. We have been performing laparoscopic prostate sparing radical cystectomy for over two years and have found it oncologically safe, reproducible and with promising functional benefits, and hence presents a good option in selective patients.

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