| Purpose: To illuminate the reason and anatomical basis of our modified nerve-sparing radical cystectomy(NSRC)in male,explore the technical points,clinical efficacy and the difference between the nerve-sparing and the non nerve-sparing radical cystectomy(n NSRC)in our center.Methods: We treated 11 normally potent patients who had preoperative c T2N0 bladder cancer by bilateral nerve-sparing cystoprostatectomy from May 2018 to December 2020.In our procedure,the resction includes removal of the bladder,prostate,seminal vesicles,distal ureters,and regional lymph nodes.IHP as well as penis blood supply is protected carefully.Denonvilliers’ fascia and the nerve around the prostate were preserved according to current intrafascial principles.Preliminary operative,oncologic,and functional results are presented.Meanwhile,we retrospectively reviewed the clinical records of the patients undergoing non nerve-sparing radical cystectomy and orthotopic neobladder because of bladder cancer from January 2015 to December 2020.Follow-up data was collected through outpatient services and telephone.We compared the characteristics,perioperative data and functional outcomes between the two groups to explore the advantages of our modified NSRC.Results: A total of 11 patients who were potent preoperatively underwent our modified NSRC.The mean age was 55.3±7.3 years,and the median operative time was 500(460-590)min.Median follow-up was 14.8 months.We observed early and late—but not grade-III or higher—complications in five patients.Of the eleven patients,ten gained daytime continence(90.9 %)and 9(81.8 %)showed nocturnal continence at last follow-up.Regarding postoperative potency,nine of eleven(81.8 %)remained potent with or without oral medications,except for one who did not follow advice on medication and one with oral medication but the postoperative time was short(5 months).Local recurrence and positive surgical margins have not returned.18 patients with n NSRC were compared with NSRC.The mean age was 61.2±7.4 years,and the median operative time was 483.5(330-660)min in n NSRC group.All the surgeries were finished successfully without any severe complications.There was no statistical difference in median operation time,median time to diet and postoperative hospital stay(P=0.642,P=0.740,P=0.102).In terms of estimated blood loss,the NSRC group is better than n NSRC group(P=0.028).The follow-up time ranges 2-64 months.There were 3 deaths,1 non-specific tumor death and 2 deaths due to distant metastasis of bladder cancer in the n NSRC group.There were 3 patients with tumor recurrence in n NSRC group.At the last follow-up,12 patients in the n NSRC group were included in terms of continence.10 and 9 patients recovered continence during the day and night,respectively.There was no significant difference compared with the nerve-preserving group(P=0.534,P =0.545).Regarding on erectile function,8 cases had sexual function preoperatively in the n NSRC group,and 1 case recovered potency postoperatively,which was lower than that in the NSRC group(P=0.005).Conclusion: Accurately dissect IHP initially and then protect the cavernosal nerve in NSRC is conductive to erectile function and continence recovery for the patients who are potent and in early stage tumor preoperatively.Compared with n NSRC,there is no significant difference in the operation time,postoperative hospital stay and complication rate.However,NSRC possess obvious advantages in functional outcomes.Supplemental studies with additional patients and follow-ups are required to evaluate overall feasibility. |
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