Preservation of urosexual functions after radical cystectomy.

Nerve-sparing radical cystectomy with ileocecal bladder substitute is highly recommended for male patients with schistosomal bladder carcinoma and for selected male patients with transitional cell carcinoma. Twenty-three patients underwent this procedure with preservation of the distal one third of prostatic capsule and inframontanal urethra, reinforcement of the ileocecal valve, and tightening of the two levator ani muscles over the cecourethral anastomosis. Urodynamic study revealed that the closed ileocecal segment is a highly compliant reservoir, and coupled with a reinforced ileocecal valve and distal urethral mechanism resulted in a low incidence of ureteral reflux (15%) and a high degree of urinary continence (100% by day and 40% by night). The procedure does not appear to undermine the principles of oncologic surgery, offers the psychologic and functional benefits of urethral micturition for all patients, and preserves erectile potency in half of them.