Journal of Andrology
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Published-Ahead-of-Print November 22, 2005, DOI:10.2164/jandrol.05074

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Erection And Ejaculation Preserving Cystectomy With Orthotopic Urinary Diversion: Is It Feasible?

Cengiz Girgin *, Mehmet Oder , M. Oguz Sahin , Afik Sezer , Serdar Berkmen , Rusen Aydin , and Cetin Dincel

* To whom correspondence should be addressed. E-mail: girgincengiz{at}hotmail.com .

Nerve sparing techniques to preserve sexual function in men undergoing cystoprostatectomy have been documented by different centers. We evaluated the results of first 4 erection and ejaculation preserving cystectomies performed in our department. The ages of patients were between 36 to 43 years. All cases wished to maintain sexual function. Of the cases 3 had pT1 G3 TCC refractory to treatment and one had pT2a adenocarsinoma of the bladder. Extirpation of the bladder and anterior proximal prostate en bloc with preservation of the vasa deferentia, seminal vesicles, posterior prostate and neurovascular bundles was performed after pelvic lymphadenectomy. W-ileal neobladder was performed by using 40cm. of ileum. All cases had erections at the third month. Of the cases 2 had antegrade ejaculation. The ejaculate volumes were 0.8 and 1.2 cc. in cases with antegrade ejaculation. The other cases had retrograde ejaculation. All cases were continent day and night. We started CIC in 1 case because of residual urine. There were no local recurrences. One case of TCC died because of systemic disease at the postoperative 32'nd month. The most important drawback of potent cases in cystectomy decision is erectile dysfunction after radical cystectomy. This drawback causes delay of the operation and sometimes mortality. Similar to other reports our limited number of cases in this study demonstrated that erection and ejaculation could be preserved in selected group of patients.






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