Abstract

Introduction and objective: bladder carcinoma affects Egyptian at younger age and is mostly of squamous cell type. Radicle cystectomy is the only effective modality for local control, however it aggressively down regulated the quality of lif of those yong men . we performed a less aggressive radical cystectomy aiming at preservation of potency and fertility . The aim is to evaluate its impact on tumor control and quality of life.

Methods: from may 1993 to April 2003, 45 male patients, for whom a planned radical cystectomy with preservation of prostate (N=20) , both vasa differentia, seminal vesicle and prostate (N=25) had done. Age ranged from 30 -48 years. The tumor was squamous carcinoma in 38 cases (84%), and TCC in 7 cases (16%). Tumor stage was T2a (25 cases) and T2a (20 cases). All cases were well or moderately differentiated squamous cell carcinoma and grade 1 or 2TCC. They were compared to comparable groups of 50 patients for whom classic radicle cystectomy with orthotropic diversion was performed.

Results: in prostate sparing cystectomy group (20 cases): tumor recurrence at bladder neck region was recorded in 3(15%) cases after6 years. All patients gained continence after catheter removal. Pouch distention (retention) developed 3 yaesr postoperative in all ileal neobladder cases (12/12) and in one patient colonic bladder cases (1/8) and managed by CIC and or TURP. Three (15%) cases with huge neobalder distention developed upper UT dilatation. Eighteen (90%) patients were sexually active and potent. in genital sparing cystectomy group (25 cases):tumor recurrence recorded in 4(16%)cases.. continence (day and night) was reported in all patients. Pouch distention reported in 7(28%) cases only. Twenty-two (88%) were sexually potent. Antegrade ejaculation was attained in 18 (72%) cases. In the comparison group (50patients): tumor recurrence occurred in 12 (24%) cases. seven patients were incontinent at night and 3 (6%) were totally incontinent. potency was maintained in 28 (56%) patients and 15 (30%)complained of varying degrees of rectal dysfunction. while 7 (14%) were totally impotent

Conclusion: modified radicle cystectomy with preservation of prostate, seminal vesicles and vasa can be safely applied for young men with bladder carcinoma away from bladder neck area. The tumor should be in early stage 2a or 2b, of well or moderate grade of differentiation and negative lymph nodes. A colonic segment is better chosen for orthotropic diversion to overcome the increasing outflow resistance with age.