Kitamura T, Moriyama N, Shibamoto K, Ueki T, Fukutani K, Kawabe K, Aso Y
Department of Urology, Branch Hospital, Faculty of Medicine, University of Tokyo, Japan.
Urol Int. 1987;42(5):375-9. doi: 10.1159/000281997.
Twenty-three patients who underwent conventional total cystectomy were examined regarding postoperative potency. Two patients who were subjected to simple cystectomy and whose partial prostate and whole seminal vesicles were left showed full erection and normal ejaculation 1-2 months after surgery, thus giving 100% potency after simple cystectomy. In contrast, of 12 patients who underwent radical cystectomy alone, only 3 (25%) regained potency postoperatively, and the strength and duration of erection were not satisfactory for 1 of the 3 patients. Nine patients who received radical cystectomy and urethrectomy did not show signs of potency postoperatively. The sum total postoperative potency rate in the 21 patients subjected to radical cystectomy was 14.3% (3/21). The facts may indicate that urethrectomy is harmful for postoperative potency because damage of the cavernous nerves probably takes place during surgery. To avoid nerve damage, the urethra should be left intact during radical cystectomy employing the nerve-sparing technique developed by Walsh and Donker unless the posterior urethra is invaded by bladder carcinoma. In addition, it was demonstrated that pelvic irradiation might cause impotency as neither pelvic lymph node dissection nor cisplatin administration had any influence on postoperative potency.
对23例行传统全膀胱切除术的患者进行了术后性功能检查。2例行单纯膀胱切除术且保留部分前列腺和整个精囊的患者在术后1 - 2个月勃起功能完全恢复且射精正常，因此单纯膀胱切除术后性功能恢复率为100%。相比之下，12例仅行根治性膀胱切除术的患者中，术后仅3例（25%）恢复性功能，其中1例患者勃起的强度和持续时间并不理想。9例行根治性膀胱切除术和尿道切除术的患者术后未表现出性功能恢复迹象。21例行根治性膀胱切除术患者的术后性功能恢复率总计为14.3%（3/21）。这些事实可能表明尿道切除术对术后性功能有害，因为海绵体神经可能在手术过程中受到损伤。为避免神经损伤，在采用Walsh和Donker开发的保留神经技术进行根治性膀胱切除术时，除非后尿道受膀胱癌侵犯，否则应保留尿道完整。此外，研究表明盆腔放疗可能导致阳痿，因为盆腔淋巴结清扫术和顺铂给药对术后性功能均无影响。
