Colombo Renzo, Bertini Roberto, Salonia Andrea, Naspro Richard, Ghezzi Massimo, Mazzoccoli Bruno, Deho' Federico, Montorsi Francesco, Rigatti Patrizio
Department of Urology, University Vita-Salute San Raffaele, Scientific Institute H. San Raffaele, Milan, Italy.
J Urol. 2004 May;171(5):1819-22; discussion 1822. doi: 10.1097/01.ju.0000123781.49896.fe.
We assessed postoperative clinical outcomes such as day and nighttime urinary continence and overall sexual function in patients who underwent nerve and seminal sparing cystectomy with ileocapsuloplasty compared with patients after standard cystoprostatectomy with similar orthotopic urinary reservoir.
A total of 27 patients (mean age 52 years, range 36 to 61) with superficial high risk or muscular invasive T2 bladder cancer underwent radical nerve and seminal sparing cystectomy with ileocapsule anastomosis. Postoperative clinical outcomes such as urinary continence, voiding patterns and urodynamic parameters were evaluated at 3, 6 and 12 months, while overall sexual function was determined at baseline and at 6 and 12-month followup.
Nerve and seminal sparing cystectomy provides better outcomes in terms of urinary and urodynamic parameters compared to standard cystoprostatectomy. Furthermore, fully normal postoperative erectile function and satisfactory overall sexual quality of life were documented at early and delayed followup in all patients. A retrograde ejaculation with reliable sperm retrieval from urine was also documented.
Although these findings need to be confirmed in a larger patient population, when respecting rigorous patient selection criteria and careful postoperative surveillance, nerve and seminal sparing cystectomy seems to offer satisfactory clinical and functional outcomes. From an oncological point of view, long-term followup is of paramount importance to confirm whether this surgical procedure can be proposed as a valid choice of treatment for young, fully potent and socially active patients with organ confined bladder cancer.
我们评估了接受保留神经和精囊的膀胱切除术并进行回肠囊成形术的患者与接受类似原位尿液储库的标准膀胱前列腺切除术的患者相比的术后临床结果，如日间和夜间尿失禁以及整体性功能。
共有27例（平均年龄52岁，范围36至61岁）浅表高危或肌层浸润性T2期膀胱癌患者接受了保留神经和精囊的根治性膀胱切除术并进行回肠囊吻合术。在3、6和12个月时评估术后临床结果，如尿失禁、排尿模式和尿动力学参数，而在基线以及6和12个月随访时确定整体性功能。
与标准膀胱前列腺切除术相比，保留神经和精囊的膀胱切除术在尿液和尿动力学参数方面提供了更好的结果。此外，在所有患者的早期和延迟随访中均记录到术后勃起功能完全正常且整体性生活质量令人满意。还记录到逆行射精且可从尿液中可靠地获取精子。
尽管这些发现需要在更大的患者群体中得到证实，但在遵循严格的患者选择标准和仔细的术后监测时，保留神经和精囊的膀胱切除术似乎能提供令人满意的临床和功能结果。从肿瘤学角度来看，长期随访对于确认这种手术方法是否可作为年轻、性功能完全正常且社交活跃的局限性膀胱癌患者的有效治疗选择至关重要。
