Cystoprostatectomy and Substitution Cystoplasty for Locally Invasive Bladder Cancer

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Abstract
Summary— The results and long‐term follow‐up of 48 patients undergoing cystoprostatectomy and substitution cystoplasty for T2/3, MO transitional cell carcinoma of the bladder are reported. There was no operative mortality but 1 early death from thromboembolic disease. Thirty‐six patients are alive with a mean follow‐up of 57 months (range 12–120). Eleven patients died of disseminated disease. Thirty‐one patients (64%) regained normal continence by day and night and a further 8 were dry by day but incontinent at night; 9 patients underwent further surgery for incontinence and this was successful in 8, giving an overall continence rate of 79% and a day‐time continence rate of 98%. Of the 38 patients claiming to be potent pre‐operatively, 24 (63%) were potent postoperatively. Nerve‐sparing cystoprostatectomy and substitution cystoplasty is a safe alternative to a “standard” cystectomy and ileal conduit diversion in a selected group of men undergoing radical surgery for invasive bladder cancer and it achieves its aims of preserving continence and potency in the majority of patients.