'Nerve-sparing' cystectomy in women.

Although the indications for cystectomy other than for cancer are few, it is occasionally necessary for severe interstitial cystitis or hemorrhage due to radiation cystitis. The use of substitution cystoplasty after cystectomy has increased in men in the last decade, and this has resulted in the development of 'nerve-sparing' approach to cystectomy to improve continence and potency. The use of substitution cystoplasty in women after cystectomy has lagged behind that in men because it was considered necessary to remove the entire urethra, making orthotopic substitution impossible. Recently the need to remove the entire urethra has been questioned, with the finding that if the bladder neck is free of tumour, recurrence of disease in the urethra has not so far been found to occur. In addition, it appears possible to substitute on to the urethra without incontinence. This has led to the development of a 'nerve-sparing' technique of cystectomy, and renewed interest in the anatomy of the urethra. This paper reviews the current literature on 'nerve-sparing' cystectomy and describes our technique.