Capsule Sparing' Cystoprostadenectomy for Orthotopic Bladder Replacement: Overcoming the Problems of Impotence, Incontinence and Difficult Urethral Anastomosis

Objective: to report a new procedure namely ‘capsule sparing’ cystoprostadenctomy for orthotopic bladder replacement that overcomes the problems of difficult urethral anastomosis, impotence and incontinence. The question addressed in the present study was whether the objectives of ‘nerve‐sparing’ cystectomy and orthotopic bladder replacement can be preserved, the incidence of incontinence and impotence improved, and surgery made easier and less demanding without compromising the radical excision of cancer.

Patients and methods: The new surgery was implemented on 4 patients with confined bladder cancer as replacement for ‘nerve sparing’ cystprostadenectoy. The new technique is described in which cystoprostadenctomy for orthotopic bladder replacement while sparing the prostatic capsule.

Results: The objectives of ‘nerve‐sparing’ cystectomy and orthotopic bladder replacement are preserved, the incidence of incontinence and impotence improved, and surgery made easier and less demanding without compromising the radical excision of cancer.

Conclusion: The spared prostatic capsule overcomes the technical difficulty of urethral anastomosis to the neobladder replacement, allowing an easy and robust anastomosis, faster surgery, minimal leakage, no complications and a shorter hospital stay. Preserving potency and continent normal voiding improves the social image and quality of life, both appreciated by the patient.

Keywords: Bladder cancer, Cystoprostadenectomy, Nerve sparing cystectomy, New technique, Capsule sparing.