Introduction: For patients who undergo radical cystectomy (RC) with orthotopic neobladder, erectile dysfunction and urinary symptoms may have a large impact in quality of life. This video demonstrates our prostate-capsule sparing radical cystectomy (PSC-RC) surgical technique, which may improve these functional outcomes in appropriately selected patients.
Methods: In this video demonstration, we describe development of the posterior plane and dissection anterior to the seminal vesicles and vas deferens. The Space of Retzius is entered and the bladder mobilized anteriorly. The prostatic capsule is incised at the 11 o’clock and 1 o’clock positions and the prostate adenoma enucleated. The urethra is transected distally to the prostate adenoma. A modified W-pouch orthotopic neobladder is then created using 30 cm of dependent terminal ileum approximately 25-30cm proximal to the ileocecal valve. The ileum is first detubularized, followed by sewing of the posterior plate. The urethroenteric anastomosis is performed, following by closure of the anterior plate of the neobladder. The ureteroenteric anastomoses are then completed using the proximal and distal end of the neobladder pouch.
Results: Data presented in several papers indicates high levels of both daytime and nighttime continence. Satisfactory erectile function is similarly high. When compared to conventional RC, PSC-RC is associated with improved functional outcomes. In our patient series, oncologic outcomes are similar to conventional RC techniques with improved erectile and urinary function.
Conclusions: PCS-RC is associated with improved erectile function and continence when compared to more conventional RC techniques. Our video describes a PCS-RC technique with modified W-pouch orthotopic neobladder reconstruction.
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