Seminal-Sparing Cystectomy in Benign Diseases of the Bladder

Abstract

Purpose

Seminal-sparing cystectomy is reported in literature only with reference to oncological conditions. However, it can be applied also in non-neoplastic conditions in young patients with good renal function. In the present report we will describe our experience in this field, with special reference to erectile function, urinary continence, fertility and feasibility.

Materials and Methods

Between 2000 and 2009 we have treated five patients with seminal-sparing cystectomy for benign conditions, namely sclerosing cystitis, tuberculosis and a benign paraganglioma. All patients underwent a complete diagnostic evaluation including CT of upper abdomen and pelvis, and bone scintigraphy. Digital rectal examination was normal, PSA less than 2.5, with a free to total ratio above 25%. Cystectomy was performed, leaving in situ vas deferent, seminal vesicles, neurovascular bundles and prostatic capsule. Finally, an orthotopic bladder was performed. The ileal segment was anastomized to the prostatic capsule.

Results

All patients had uneventful recoveries and were continent within 2 weeks from the operation. Erectile function was maintained in all cases; in one patients fertility was preserved.

Conclusions

In our experience, seminal-sparing cystectomy showed satisfactory clinical and functional preliminary results in selected patients. Young males, for whom maintenance of bladder function and sexual activity have a great impact on their quality of life, can be offered this alternative surgical procedure.