Seminal Vesical Sparing Cystectomy for Bladder Cancer is Feasible with Good Functional Results without Impairing Oncological Outcomes: A Longitudinal Long-Term Propensity-Matched Single Center Study

No AccessJournal of UrologyAdult Urology1 Jun 2021Seminal Vesical Sparing Cystectomy for Bladder Cancer is Feasible with Good Functional Results without Impairing Oncological Outcomes: A Longitudinal Long-Term Propensity-Matched Single Center StudyThis article is commented on by the following:Editorial Comment Marc A. Furrer, Bernhard Kiss, Urs E. Studer, Patrick Y. Wuethrich, Brigitta Gahl, Roland Seiler, Beat Roth, Piet Bosshard, Benjamin C. Thomas, Fiona C. Burkhard, Silvan Boxler, and George N. Thalmann Marc A. FurrerMarc A. Furrer *Correspondence: Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland E-mail Address: [email protected] Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Department of Urology, The University of Melbourne, Royal Melbourne Hospital, Victoria, Australia , Bernhard KissBernhard Kiss Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland , Urs E. StuderUrs E. Studer Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland , Patrick Y. WuethrichPatrick Y. Wuethrich Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland , Brigitta GahlBrigitta Gahl Clinical Trials Unit Bern, University of Bern, Bern, Switzerland , Roland SeilerRoland Seiler Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland , Beat RothBeat Roth Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Department of Urology, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Switzerland , Piet BosshardPiet Bosshard Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Department of Urology, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Switzerland , Benjamin C. ThomasBenjamin C. Thomas Department of Urology, The University of Melbourne, Royal Melbourne Hospital, Victoria, Australia , Fiona C. BurkhardFiona C. Burkhard Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland , Silvan BoxlerSilvan Boxler Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland , and George N. ThalmannGeorge N. Thalmann Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland View All Author Informationhttps://doi.org/10.1097/JU.0000000000001635AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Seminal vesicle-sparing radical cystectomy has been reported to improve short-term functional results without compromising oncological outcomes. However, there is still a lack of data on long-term outcomes after seminal vesicle-sparing radical cystectomy. The aim of this study was to compare oncological and functional outcomes in patients after seminal vesicle-sparing vs nonseminal vesicle-sparing radical cystectomy. Materials and Methods: Oncological and functional outcomes of 470 consecutive patients after radical cystectomy and orthotopic ileal reservoir from 2000 to 2017 were evaluated. They were stratified into 6 groups according to nerve-sparing and seminal vesicle-sparing status as attempted during surgery: no sparing at all (55), unilateral nerve sparing (159), bilateral nerve sparing (132), unilateral seminal vesicle-sparing and unilateral nerve sparing (30), unilateral seminal vesicle sparing and bilateral nerve sparing (45), and bilateral seminal vesicle sparing (49) and used propensity modeling to adjust for preoperative differences. Results: Median followup among the entire cohort was 64 months. Among the 6 groups, our analysis showed no difference in local recurrence-free survival (p=0.173). However, progression-free, cancer-specific and overall survival were more favorable in patients with seminal vesicle-sparing radical cystectomy (p <0.001, p=0.006 and p <0.001, respectively). Proportions of patients with erectile function recovery were higher in the seminal vesicle-sparing groups at all time points in all analyses, respectively, with pronounced earlier recovery in patients with bilateral seminal vesicle sparing. Importantly, patients with seminal vesicle sparing were significantly less in need of erectile aids to achieve erection and intercourse. Over the whole period, daytime urinary-continence was significantly better in the seminal vesicle sparing groups (OR 2.64 to 5.21). Conclusions: In a highly selected group of patients, seminal vesicle sparing radical cystectomy is oncologically safe and results in excellent functional outcomes that are reached at an earlier time point after surgery and remain superior over a longer period of time. 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Furrer Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Department of Urology, The University of Melbourne, Royal Melbourne Hospital, Victoria, Australia *Correspondence: Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland E-mail Address: [email protected] More articles by this author Bernhard Kiss Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland More articles by this author Urs E. Studer Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland More articles by this author Patrick Y. Wuethrich Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland More articles by this author Brigitta Gahl Clinical Trials Unit Bern, University of Bern, Bern, Switzerland More articles by this author Roland Seiler Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland More articles by this author Beat Roth Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Department of Urology, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Switzerland More articles by this author Piet Bosshard Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Department of Urology, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Switzerland More articles by this author Benjamin C. Thomas Department of Urology, The University of Melbourne, Royal Melbourne Hospital, Victoria, Australia More articles by this author Fiona C. Burkhard Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland More articles by this author Silvan Boxler Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Equal study contribution. More articles by this author George N. Thalmann Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Equal study contribution. More articles by this author Expand All Advertisement PDF DownloadLoading ...