What is a nerve sparing radical cystectomy?

Updated: Nov 27, 2016
  • Author: Michael Christopher Large, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Nerve-sparing radical cystectomy is a technique that can be used to preserve erectile function. Postoperative potency is 40%-50% in optimally selected patients, namely men without tumors at the bladder base or prostate.

Most of the dissection is performed in a retrograde manner. The apex of the prostate is addressed first, using a technique virtually identical to that used for a nerve-sparing radical prostatectomy. The nerves are most commonly damaged at the apex and at the tips of the seminal vesicle—an important point to remember during dissection. The best candidates for this procedure are patients who have superficial TCC or invasive disease that does not involve the base of the bladder posteriorly because they have a lower risk of disease extension posterolaterally. An appropriate cancer surgery takes utmost precedence; abandon nerve sparing if the patient's cancer status posterolaterally is of any concern.

Survival rates are comparable with those of the traditional approach in appropriately

selected patients. Nerve-sparing cystectomy has also been associated with improved neobladder continence rates, although the exact mechanism is unclear.


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