Radical cystoprostatectomy has become the standard procedure for treatment of invasive
urinary bladder carcinoma which necessitates an internal urinary diversion (e.g.
ureterosigmoidostomy) or external urinary diversion (e.g. Heal conduit). For resorting normal
voiding, various bowel segments have been used for constructing an orthotopic bladder pouch
substitute either from ileum, caecum and ileum (Mainz) or sigmoid. Despite the therapeutic
advantages, radical cystoprostatectomy- represents a--major intervention, accompanied by
morbidity rates where some patients maintain severe diurenal incontinence and almost half of
cases remain with nocturnal enuresis for extended periods. On the other hand, even when
employing the technique for preserving the cavernous bundles, only 50% of the treated patients
show evidence of penile erections post-operatively. Now, an alternative technique of radical
retropubic extraperitoneal cystoprostatectomy for orthotopic bladder substitution with
"prostate capsule- sparing" that preserves the neurovascular plexus, assuring better potency
and continent normal voiding, and making the neo-vesicocapsular anastomosis easier, without
compromising radical cancer excision. In this work, fifteen patients with invasive urinary
bladder carcinoma were subjected to radical cystoprostatectomy with preservation of prostatic
capsule and wide anastomosis between ileal neobladder and prostatic capsule was done. The
post-operative follow up included continence and potency scoring.
Fifteen patients had radical cystoprostatectomy with preservation of prostatic
capsule.Immediate day time urinary control was achieved by all patients following catheter
removal. Immediate nigh time control was achieved by all except one case who experienced
initial mild nocturnal leakage, which resolved within the following 2 months. Two patients
developed transient nocturnal frequency. Two patients experienced prolonged suprapubic tube
site leakage before eventual healing, without consequence to uretheral voiding or continence.
One patient had anastomotic leak and one patient developed adhesive small bowel obstruction.
Conclusions: This study concluded that radical retropubic cystoprostatectomy with
preservation of prostatic capsule with orthotopic neobladder reconstruction provided excellent
immetliate and long-term functional voiding and continence with good erectile function. By
eliminating the prostatic dissection, this modified technique provides improvement in intraoperative
and postoperative morbidity without subsequent compromise of oncological success. |
