Prostate sparing radical cystectomy and neobladder: institutional long-standing qualified consideration.

OBJECTIVES

To balance the extended functional urinary voiding and morbidity outcomes amid Ileal W and Y-shaped contrasted to spherical ileocoecal (IC) orthotopic bladders subsequent prostate-sparing radical cystectomy (PRC) versus standard radical cystoprostatectomy (RC).

MATERIAL AND METHODS

Two hundred eight male bladder cancer patients were grouped into 98 RC followed by 43-W, 31-Y, and 23-IC in comparison to 110 PRC followed by 35-W, 37-Y, and 38-IC. The functional voiding outcomes were determined by detailed patients' interview and urodynamic studies (UDS).

RESULTS

Twenty-four hour pad-free continence for PRC at the 6th month was (37, 25, and 36%) as regards W, Y, and IC in that order, improved to (51, 44, and 51%) at the 12th month and (68, 70, 73%) at the 5th year. Nocturnal continence at the 12th month was (60, 56 and 59%). After 73 months median surveillance, day-time control was 90% equal for the 3 pouch configurations. RC patients faced inferior continence rates exclusively during nocturnal time. Urethral pressures started higher for PRC and increased over time, resulting in diminution of stress frequency. Delayed pouch morbidities were 41% for W vs. 22.4% and 25% among Y and IC series. Urethral recurrences were non-existent in both groups without atypical or metaplastic changes. Mucosal pattern persisted in 60% while muscular coat atrophied in 83% of ileal and 40% of colon walls.

CONCLUSION

Voiding control parameters for PRC were significantly superior. Though early continence is in favor of W pouches, delayed observation showed equivalent Y and IC results besides least delayed pouch-related morbidities for IC.