Introini Carlo, Sequi Manfredi Bruno, Ennas Marco, Benelli Andrea, Guano Giovanni, Pastore Antonio Luigi, Carbone Antonio
E.O. Ospedali Galliera, UOC Urologia, 16128 Genova, Italy.
Urology Unit, Department of Medico-Surgical Sciences & Biotechnologies, Faculty of Pharmacy & Medicine, Sapienza University of Rome, 04100 Latina, Italy.
Cancers (Basel). 2025 Jan 1;17(1):110. doi: 10.3390/cancers17010110.
: Radical cystectomy (RC) is the standard treatment for muscle-invasive and high-risk non-muscle-invasive bladder cancer, but it often results in significant functional impairments, including sexual and urinary dysfunction, adversely affecting quality of life (QoL). Sexual-sparing robotic-assisted radical cystectomy (RARC) has been introduced to mitigate these effects. This review evaluates the oncological and functional outcomes of sexual-sparing RARC in male and female patients. : A systematic literature search identified 15 studies including 793 patients who underwent sexual-sparing RARC using techniques such as nerve-sparing, capsule-sparing, and pelvic organ-preserving approaches. Data on oncological and functional outcomes were analyzed. : Sexual-sparing RARC achieves oncological outcomes comparable to open RC, with negative surgical margin (NSM) rates exceeding 95% in most studies. RFS and CSS rates were robust, often surpassing 85% at intermediate follow-ups. Functional outcomes were also favorable, with continence rates exceeding 90% and erectile function recovery surpassing 70% in well-selected male patients. Female patients undergoing pelvic organ-preserving techniques demonstrated improved continence, preserved sexual function, and enhanced QoL. Patient selection emerged as critical, favoring those with organ-confined disease and good baseline function. : Sexual-sparing RARC offers a promising balance between oncological control and functional preservation, making it an effective option for selected patients. Further research is needed to refine techniques and establish standardized protocols for broader adoption.
根治性膀胱切除术（RC）是肌层浸润性和高危非肌层浸润性膀胱癌的标准治疗方法，但它常常导致显著的功能障碍，包括性功能和排尿功能障碍，对生活质量（QoL）产生不利影响。保留性功能的机器人辅助根治性膀胱切除术（RARC）已被引入以减轻这些影响。本综述评估了保留性功能的RARC在男性和女性患者中的肿瘤学和功能结局。
一项系统的文献检索确定了15项研究，包括793例采用保留神经、保留包膜和保留盆腔器官等技术接受保留性功能的RARC的患者。对肿瘤学和功能结局的数据进行了分析。
保留性功能的RARC取得的肿瘤学结局与开放性RC相当，在大多数研究中阴性手术切缘（NSM）率超过95%。无复发生存率（RFS）和癌症特异性生存率（CSS）较高，在中期随访时通常超过85%。功能结局也较好，在精心挑选的男性患者中，控尿率超过90%，勃起功能恢复率超过70%。接受保留盆腔器官技术的女性患者控尿改善、性功能保留且生活质量提高。患者选择至关重要，更适合患有器官局限性疾病且基线功能良好的患者。
保留性功能的RARC在肿瘤学控制和功能保留之间提供了一个有前景的平衡，使其成为特定患者的有效选择。需要进一步研究来完善技术并建立标准化方案以实现更广泛的应用。
