Modified Completely Intrafascial Radical Cysprostatectomy for Bladder Cancer: a Single-center, Blinded, Controlled Study

Overview

Journal BMC Cancer

Publisher Biomed Central

Specialty Oncology

Date 2021 Aug 3

PMID 34340675

Authors

Xiao Wang

Jia Guo

Lei Wang

Min Wang

Xiaodong Weng

Hui Chen

Xiuheng Liu

Affiliations

Soon will be listed here.

Abstract

Background: We have proposed a modified, completely intrafascial radical cysprostatectomy (RC) to treat bladder cancer patients with the aim of preserving the patients' post-surgical urinary control and erectile function. This study aimed to evaluate the oncological and functional outcomes of this innovation relatively to that with the conventional technique.

Methods: A retrospective, single-center, blinded, and controlled study was conducted using the medical data of patients since the past 5 years from the hospital database. A total of 44 patients were included, including 20 who received complete intrafascial cysprostatectomy and 24 who received conventional interfascial surgeries. The patients' continent and sexual information of 1-year follow-up after the surgery were extracted. The oncological and functional outcomes of the 2 groups were compared and analyzed.

Results: The demographics parameters of the 2 groups showed no significant difference. The results of follow-up of the oncological outcomes did not reveal any significant difference between the completely intrafascial group and the conventional interfascial group in terms of the positive surgical margins, local recurrences, and distant metastasis. Patients following neobladder diversion in the intrafascial group showed a faster recovery of the urinary control, with a 76.9% (10/13) daytime continent rate at 3-month, as well as 46.2% (6/13) and 58.3% (7/12) nighttime continent rates at 3-month and 6-month, respectively. Regarding the sexual functions, our results revealed significant advantages in favor of completely intrafascial technique on the post-surgical International Index of Erectile Function (IIEF)-5 score at 3-, 9-, and 12-month follow-up relative to that with the conventional interfascial process. Thus, the IIEF score of patients in the intrafascial group was 11.4 ± 3.5 at 3-month, 14.1 ± 3.6 at 9-month, and 15.2 ± 3.8 at 12-month follow-up after the cystectomy, which was significantly greater than that of the patients in the control group.

Conclusions: Our novel data illustrated that the modified completely intrafascial technique could result in a better sexual function and faster continence recovery for patients following RC, without any compromise in the cancer control. Thus, this technique could be considered as an alternative extirpative technique for bladder cancer treatment in a clinical setting.

Citing Articles

Long-term Outcomes of Prostate Capsule-Sparing and Nerve-Sparing Radical Cystectomy With Neobladder: A Propensity Score-Matched Comparison.

Zhu Z, Zhu Y, Shi H, Zhou P, Xue Y, Hu S Int Neurourol J. 2025; 28(4):270-277.

PMID: 39765339 PMC: 11710957. DOI: 10.5213/inj.2448348.174.

References

Lunacek A, Schwentner C, Fritsch H, Bartsch G, Strasser H . Anatomical radical retropubic prostatectomy: 'curtain dissection' of the neurovascular bundle. BJU Int. 2005; 95(9):1226-31. DOI: 10.1111/j.1464-410X.2005.05510.x. View

Ferro M, Di Lorenzo G, Vartolomei M, Bruzzese D, Cantiello F, Lucarelli G . Absolute basophil count is associated with time to recurrence in patients with high-grade T1 bladder cancer receiving bacillus Calmette-Guérin after transurethral resection of the bladder tumor. World J Urol. 2019; 38(1):143-150. DOI: 10.1007/s00345-019-02754-2. View

Del Giudice F, Leonardo C, Simone G, Pecoraro M, De Berardinis E, Cipollari S . Preoperative detection of Vesical Imaging-Reporting and Data System (VI-RADS) score 5 reliably identifies extravesical extension of urothelial carcinoma of the urinary bladder and predicts significant delayed time to cystectomy: time to reconsider.... BJU Int. 2020; 126(5):610-619. DOI: 10.1111/bju.15188. View

Menon M, Shrivastava A, Bhandari M, Satyanarayana R, Siva S, Agarwal P . Vattikuti Institute prostatectomy: technical modifications in 2009. Eur Urol. 2009; 56(1):89-96. DOI: 10.1016/j.eururo.2009.04.032. View

Zippe C, Raina R, Massanyi E, Agarwal A, Stephen Jones J, Ulchaker J . Sexual function after male radical cystectomy in a sexually active population. Urology. 2004; 64(4):682-5. DOI: 10.1016/j.urology.2004.05.056. View

Hernandez V, Linares Espinos E, Dunn J, MacLennan S, Lam T, Yuan Y . Oncological and functional outcomes of sexual function-preserving cystectomy compared with standard radical cystectomy in men: A systematic review. Urol Oncol. 2017; 35(9):539.e17-539.e29. DOI: 10.1016/j.urolonc.2017.04.013. View

Nicolazzo C, Busetto G, Gradilone A, Sperduti I, Del Giudice F, Loreni F . Circulating Tumor Cells Identify Patients with Super-High-Risk Non-Muscle-Invasive Bladder Cancer: Updated Outcome Analysis of a Prospective Single-Center Trial. Oncologist. 2019; 24(5):612-616. PMC: 6516110. DOI: 10.1634/theoncologist.2018-0784. View

Del Giudice F, Barchetti G, De Berardinis E, Pecoraro M, Salvo V, Simone G . Prospective Assessment of Vesical Imaging Reporting and Data System (VI-RADS) and Its Clinical Impact on the Management of High-risk Non-muscle-invasive Bladder Cancer Patients Candidate for Repeated Transurethral Resection. Eur Urol. 2019; 77(1):101-109. DOI: 10.1016/j.eururo.2019.09.029. View

Ganzer R, Stolzenburg J, Neuhaus J, Weber F, Fuchshofer R, Burger M . Anatomical study of pelvic nerves in relation to seminal vesicles, prostate and urethral sphincter: immunohistochemical staining, computerized planimetry and 3-dimensional reconstruction. J Urol. 2014; 193(4):1205-12. DOI: 10.1016/j.juro.2014.10.001. View

10.

Walz J, Burnett A, Costello A, Eastham J, Graefen M, Guillonneau B . A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy. Eur Urol. 2009; 57(2):179-92. DOI: 10.1016/j.eururo.2009.11.009. View

11.

Kessler T, Burkhard F, Perimenis P, Danuser H, Thalmann G, Hochreiter W . Attempted nerve sparing surgery and age have a significant effect on urinary continence and erectile function after radical cystoprostatectomy and ileal orthotopic bladder substitution. J Urol. 2004; 172(4 Pt 1):1323-7. DOI: 10.1097/01.ju.0000138249.31644.ec. View

12.

Hautmann R, Stein J . Neobladder with prostatic capsule and seminal-sparing cystectomy for bladder cancer: a step in the wrong direction. Urol Clin North Am. 2005; 32(2):177-85. DOI: 10.1016/j.ucl.2005.02.001. View

13.

Budaus L, Isbarn H, Schlomm T, Heinzer H, Haese A, Steuber T . Current technique of open intrafascial nerve-sparing retropubic prostatectomy. Eur Urol. 2009; 56(2):317-24. DOI: 10.1016/j.eururo.2009.05.044. View

14.

Colombo R, Pellucchi F, Moschini M, Gallina A, Bertini R, Salonia A . Fifteen-year single-centre experience with three different surgical procedures of nerve-sparing cystectomy in selected organ-confined bladder cancer patients. World J Urol. 2015; 33(10):1389-95. DOI: 10.1007/s00345-015-1482-y. View

15.

Hautmann R, de Petriconi R, Volkmer B . Lessons learned from 1,000 neobladders: the 90-day complication rate. J Urol. 2010; 184(3):990-4. DOI: 10.1016/j.juro.2010.05.037. View

16.

Wang X, Wu Y, Guo J, Chen H, Weng X, Liu X . Oncological safety of intrafascial nerve-sparing radical prostatectomy compared with conventional process: a pooled review and meta-regression analysis based on available studies. BMC Urol. 2019; 19(1):41. PMC: 6537360. DOI: 10.1186/s12894-019-0476-2. View

17.

Walz J, Epstein J, Ganzer R, Graefen M, Guazzoni G, Kaouk J . A Critical Analysis of the Current Knowledge of Surgical Anatomy of the Prostate Related to Optimisation of Cancer Control and Preservation of Continence and Erection in Candidates for Radical Prostatectomy: An Update. Eur Urol. 2016; 70(2):301-11. DOI: 10.1016/j.eururo.2016.01.026. View

18.

Kaul S, Menon M . Robotic radical prostatectomy: evolution from conventional to VIP. World J Urol. 2006; 24(2):152-60. DOI: 10.1007/s00345-006-0101-3. View

19.

Botto H, Sebe P, Molinie V, Herve J, Yonneau L, Lebret T . Prostatic capsule- and seminal-sparing cystectomy for bladder carcinoma: initial results for selected patients. BJU Int. 2004; 94(7):1021-5. DOI: 10.1111/j.1464-410X.2004.05097.x. View

20.

Kaul S, Savera A, Badani K, Fumo M, Bhandari A, Menon M . Functional outcomes and oncological efficacy of Vattikuti Institute prostatectomy with Veil of Aphrodite nerve-sparing: an analysis of 154 consecutive patients. BJU Int. 2006; 97(3):467-72. DOI: 10.1111/j.1464-410X.2006.05990.x. View