V10-10: The Role of Robotic Cysto-prostatectomy with Bilateral Nerve and Apex Preservation in Young Patients with Bladder Cancer
VideoIntroductions and Objectives
Young males (
Ports are placed in the standard cystectomy fashion as previously described in the “W” configuration with a 12 mm assistant port on the right side of the patient. The patient is placed in the steep trendelenberg position and the robot is docked. The ureters are dissected followed by posterior rectal dissection. The pedicles are then carefully dissection with Hem-o-lock (Weck) clips with minimal electrocautery in the vicinity of the neurovascular bundles. Bilateral intra-fascial nerve dissection is performed followed by close apical dissection of the prostate. The dorsal venous complex is preserved followed by division of the urethra, creating a robust, long stump. Urinary diversion is performed at surgeon preference.
We have performed three robotic cystectomies with apex preservation followed by totally intra-corporeal neobladders. All patients did not have evidence of prostatic urethral or intraductal involvement of their bladder cancer and their preoperative PSA values were normal. All patients reported preoperative SHIM scores above 23 and experienced rapid recovery of erectile function post-operatively with full daytime continence. All patients had negative margins with long-term data pending.
Robotic cysto-prostatectomy with bilateral nerve and apical preservation can be performed safely in the properly selected young patient with excellent results. A larger series with prospective randomized trials will be needed to assess the long-term implications and benefits.