En bloc radical cystoprostatourethrectomy with preservation of sexual function.

BACKGROUND

Recent understanding of the precise anatomy of the cavernous nerves to the penis allows us to preserve potency in men undergoing radical prostatectomy or radical cystoprostatectomy. A technique of urethrectomy that preserves potency has been also developed. To date, however, delayed urethrectomy has been recommended to preserve potency. We have applied a nerve-sparing technique to en bloc cystoprostatourethrectomy.

METHODS

Seven patients have undergone simultaneous urethrectomy with the radical cystoprostatectomy by the nerve-sparing technique. Patient age ranged from 52 to 69 years (mean age, 61.3 years). All patients were potent preoperatively. Meticulous and complete dissection of the membranous urethra from the pelvis is the key to preservation of potency at urethrectomy.

RESULTS

The patients were followed for 7 to 64 months (mean, 27.3 months). Four (57%) of the patients regained potency postoperatively. Two patients were able to have erections postoperatively but are still impotent.

CONCLUSIONS

Our clinical results show that it is possible to perform simultaneous urethrectomy and preserve potency.