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‘Nerve‐sparing’ cystectomy and substitution cystoplasty in patients of either sex: limitations and techniques
Author(s) -
Popert,
Mundy
Publication year - 1998
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1046/j.1464-410x.1998.00756.x
Subject(s) - cystectomy , medicine , urinary diversion , surgery , pathological , bladder cancer , urethra , urology , urinary system , urinary bladder , cancer
Objectives To determine the limitations of cystectomy and orthotopic substitution cystoplasty in men and women with bladder cancer. Patients and methods Cystectomy and orthotopic substitution cystoplasty were carried out in 79 patients (mean age 60 years, range 31–74, including eight women) who were followed for a mean of 7 years (range 1–13) to evaluate continence, potency and survival. Results Overall, 80% of the patients were continent without further treatment and 55% of the men who were potent before surgery remained so afterward. The best results were obtained with retrograde cystectomy in both sexes and are only achievable in women in this way. Continence was achieved more easily in women than in men, although pathological delineation of the tumour preoperatively and technical considerations per‐operatively make both the selection and the procedure more demanding in women than in men. Conclusions Cystectomy and orthotopic substitution cystoplasty is possible in patients of either sex and should be offered to all patients as an alternative to ileal conduit urinary diversion, unless preoperative assessment suggests that the urethra must be removed with the bladder, which is rare in men and uncommon in women. In such patients, a continent diversion may be the preferred option.