Seminal Vesical Sparing Cystectomy in Bladder Cancer Patients is Feasible with Good Functional Results without Impairing Oncological Outcomes: A Longitudinal Long-Term Propensity-Matched Single Center Study.

Furrer, Marc A.; Kiss, Bernhard; Studer, Urs E.; Wuethrich, Patrick Y.; Gahl, Brigitta; Seiler, Roland; Roth, Beat; Bosshard, Piet; Thomas, Benjamin C; Burkhard, Fiona C.; Boxler, Silvan; Thalmann, George N. (2021). Seminal Vesical Sparing Cystectomy in Bladder Cancer Patients is Feasible with Good Functional Results without Impairing Oncological Outcomes: A Longitudinal Long-Term Propensity-Matched Single Center Study. Journal of urology, 205(6), pp. 1629-1640. Elsevier 10.1097/JU.0000000000001635

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PURPOSE

Seminal-vesicle-sparing radical-cystectomy has been reported to improve short-term functional-results without compromising oncological outcomes. However, there is still a lack of data on long-term outcomes after seminal-vesicle-sparing radical-cystectomy. The aim of this study was to compare oncological and functional outcomes in patients after seminal-vesicle-sparing vs nonseminal-vesicle-sparing radical-cystectomy.

MATERIAL AND METHODS

Oncological and functional outcomes of 470 consecutive patients after radical-cystectomy and orthotopic ileal reservoir from 2000 to 2017 were evaluated. They were stratified into 6 groups according to nerve-sparing and seminal-vesicle-sparing status as attempted during surgery: no-sparing at all (n=55), unilateral-nerve-sparing (n=159), bilateral-nerve-sparing (n=132), unilateral-seminal-vesicle-sparing and unilateral-nerve-sparing (n=30), unilateral-seminal-vesicle-sparing and bilateral-nerve-sparing (n=45), and bilateral seminal-vesicle-sparing (n=49) and used propensity modelling to adjust for preoperative differences.

RESULTS

Median follow-up among the entire cohort was 64months. Among the 6 groups, our analysis showed no difference in local recurrence-free survival (p=0.173). However, progression free, cancer-specific and overall survival were more favourable in patients with seminal-vesicle-sparing radical-cystectomy (p <0.001, p=0.006 and p <0.001, respectively). Proportions of patients with erectile function recovery were higher in the seminal-vesicle-sparing groups at all time points in all analyses, respectively, with pronounced earlier recovery in patients with bilateral-SVS. Importantly, patients with seminal-vesicle-sparing were significantly less in need of erectile aids to achieve erection and intercourse. Over the whole period, daytime urinary-continence was significantly better in the seminal-vesicle-sparing groups (OR 2.64 to 5.21).

CONCLUSIONS

In a highly selected group of patients, seminal-vesicle-sparing radical-cystectomy is oncologically safe and results in excellent functional outcomes that are reached at an earlier timepoint after surgery and remain superior over a longer period of time.

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