'Nerve-sparing' cystectomy and substitution cystoplasty in patients of either sex: limitations and techniques.

ABSTRACT

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.