Huang Jian, Fan Xinxiang, Dong Wen
Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Asian J Urol. 2016 Jul;3(3):150-155. doi: 10.1016/j.ajur.2016.04.004. Epub 2016 May 27.
During radical cystectomy (RC), the neurovascular bundles are easily removed or damaged, leading to varying rates of incontinence and erectile dysfunction. The nerve-sparing technique was developed to preserve urinary and erectile function. The adoption of laparoscopic and robot-assisted technology has improved visualization and dexterity of pelvic surgeries, thus facilitate the nerve-sparing technique. Although nerve-sparing RC is technically similar with nerve-sparing radical prostatectomy, there are still some anatomical differences. There are mainly three different types of nerve-sparing techniques. Pelvic lymph node dissection (PLND) is another important factor to influence erectile function and urinary continence. Nerve-sparing laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) may be an optimal treatment choice in well-selected younger patients with low-volume, organ-confined disease. We should attempt to do, whenever possible, a nerve-sparing cystectomy at least on oneside. However, due to the need of a well-refined surgical technique, nerve-sparing LRC and RARC is now being performed only by experienced urological surgeons.
在根治性膀胱切除术（RC）过程中，神经血管束很容易被切除或损伤，从而导致不同程度的尿失禁和勃起功能障碍。保留神经技术的发展旨在保留排尿和勃起功能。腹腔镜和机器人辅助技术的应用改善了盆腔手术的视野和灵活性，从而促进了保留神经技术的开展。尽管保留神经的RC在技术上与保留神经的根治性前列腺切除术相似，但仍存在一些解剖学差异。主要有三种不同类型的保留神经技术。盆腔淋巴结清扫术（PLND）是影响勃起功能和尿失禁的另一个重要因素。保留神经的腹腔镜根治性膀胱切除术（LRC）和机器人辅助根治性膀胱切除术（RARC）可能是精心挑选的、低体积、局限于器官疾病的年轻患者的最佳治疗选择。只要有可能，我们应尝试至少在一侧进行保留神经的膀胱切除术。然而，由于需要精湛的手术技术，目前只有经验丰富的泌尿外科医生才能开展保留神经的LRC和RARC。
