Virginia Hernández1, Estefania Linares Espinos2, James Dunn3, Steven MacLennan4, Thomas Lam4, Yuhong Yuan5, Eva Compérat6, Nigel C Cowan7, Georgios Gakis8, Thierry Lebrét9, Antoine G van der Heijden10, Johannes Alfred Witjes10, Maria J Ribal11. 1. Department of Urology, Hospital Universitario Fundación de Alcorcón, Madrid, Spain. Electronic address: vhernandez@fhalcorcon.es. 2. Department of Urology, Hospital Universitario Infanta Sofía, Madrid, Spain. 3. Department of Urology, Derriford Hospital, Plymouth UK. 4. Academic Urology Unit, University of Aberdeen, Scotland, UK. 5. Department of Medicine, Health Science Centre, McMaster University, Hamilton, ON, Canada. 6. Department of Pathology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France. 7. Department of Radiology, Queen Alexandra Hospital, Portsmouth, UK. 8. Department of Urology, Eberhard-Karls University, Tübingen, Germany. 9. Department of Urology, Foch Hospital, Suresnes, France. 10. Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands. 11. Department of Urology, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Abstract
INTRODUCTION: Different sexual function-preserving surgical techniques aimed at improving voiding and sexual function in patients undergoing radical cystectomy for bladder cancer have been described. The objective of this systematic review is to determine the effect of sexual function-preserving cystectomy (SPC) on functional and oncological outcomes. MATERIALS AND METHODS: Relevant databases were searched covering the time frame 2000 to 2015. All publications presenting data on any type of SPC reporting oncological or functional outcomes with a minimum follow-up of 1 year were identified. Comparative studies including a minimum of 30 patients and single-arm case series with a minimum of 50 patients were selected. No language restrictions were applied. RESULTS: In a total of 8,517 identified abstracts, 12 studies were eligible for inclusion. SPC described included prostate-, capsule-, seminal vesicle, and nerve-sparing techniques. Local recurrence ranged from 1.2% to 61.1% (vs. 16.0%-55.0% in the control group) and metastatic disease from 0% to 33.3% (vs. 33.0%). No differences were found in comparative studies reporting oncological outcomes. Postoperative potency was significantly better in the SPC groups in 6 studies comparing sexual function-preserving cystectomy vs. radical cystectomy (P<0.05). No major effect on continence was found. Overall, there was moderate to high risk of bias and confounding. CONCLUSIONS: The evidence base for prostate-, capsule-, or nerve-sparing cystectomy suggests that these procedures may yield better sexual outcomes than standard cystectomy, without compromising oncological outcomes. However, the overall quality of the evidence was moderate, and hence if offered, patients must be carefully selected, counseled, and closely monitored.
INTRODUCTION: Different sexual function-preserving surgical techniques aimed at improving voiding and sexual function in patients undergoing radical cystectomy for bladder cancer have been described. The objective of this systematic review is to determine the effect of sexual function-preserving cystectomy (SPC) on functional and oncological outcomes. MATERIALS AND METHODS: Relevant databases were searched covering the time frame 2000 to 2015. All publications presenting data on any type of SPC reporting oncological or functional outcomes with a minimum follow-up of 1 year were identified. Comparative studies including a minimum of 30 patients and single-arm case series with a minimum of 50 patients were selected. No language restrictions were applied. RESULTS: In a total of 8,517 identified abstracts, 12 studies were eligible for inclusion. SPC described included prostate-, capsule-, seminal vesicle, and nerve-sparing techniques. Local recurrence ranged from 1.2% to 61.1% (vs. 16.0%-55.0% in the control group) and metastatic disease from 0% to 33.3% (vs. 33.0%). No differences were found in comparative studies reporting oncological outcomes. Postoperative potency was significantly better in the SPC groups in 6 studies comparing sexual function-preserving cystectomy vs. radical cystectomy (P<0.05). No major effect on continence was found. Overall, there was moderate to high risk of bias and confounding. CONCLUSIONS: The evidence base for prostate-, capsule-, or nerve-sparing cystectomy suggests that these procedures may yield better sexual outcomes than standard cystectomy, without compromising oncological outcomes. However, the overall quality of the evidence was moderate, and hence if offered, patients must be carefully selected, counseled, and closely monitored.