Squamous cell carcinoma (SCC) of the urinary bladder, although uncommon in Europe and the United States, is the most common variety of bladder tumor in countries where urinary bilharziasis prevails.1 Radical cystoprostatectomy remains the main treatment, giving a 5-year survival rate of 50%.1 However, because of its effect on sexual function, urinary control, and body image, radical cystectomy is one of the most traumatic cancer operations. Currently, in young patients undergoing radical cystectomy and continent diversion, the primary sources of symptom-induced distress are related to sexual dysfunction (ie, decreased sexual potency, reduced sexual desire, reduced intercourse, and orgasm frequency). The nerve-sparing cystoprostatectomy devised by Schlegel and Walsh2 in 1987 was proposed as an effective technique to preserve erectile function, with an 83% potency rate. However, the reports that followed have shown that even in the best surgical hands, potency maintenance is about 50%.3 To improve patients' quality of life, a technique of prostate-sparing cystectomy after transurethral resection of the prostate was described by Schilling and Friesen4 in 1990. Next, Muto et al5 were the first to report the preservation of a part of the prostate, vasa deferentia, and seminal vesicles to improve, not only postoperative continence, but also potency. Normal erectile function was preserved in 95% of patients, with 100% retrograde ejaculation.5 The results of several studies after these first experiences confirmed the efficacy of this technique in preserving sexual function and its superiority to nerve-sparing radical cystoprostatectomy, even if performed by experts in the field.6 The present report aims to determine risk factors associated with prostate invasion in a large series of patients with SCC of the urinary bladder associated with bilharziasis to define the possible candidates for seminal- and prostate-sparing cystectomy. Prostate infiltration is present in only 5.9% of the patients, probably owing to the prevalent unifocality of SCC associated with bilharziasis, as stated by the authors, and already reported in other series.7 Another interesting point is the high incidence of nodal metastases, present in 29% of patients. The authors conclude that patients with tumors located at bladder neck, >5-cm tumor size, and advanced clinical stage were associated with a greater risk of prostate invasion. Therefore, in such clinical settings, prostate- and seminal-sparing cystectomy should be contraindicated. However, most patients in the present series had nonadvanced SCC, <5 cm, and away from the bladder neck; thus, one might conclude that prostate- and seminal-sparing cystectomy can be safely performed in most patients with SCC. In contrast, prostate- and seminal-sparing cystectomy has been criticized for the treatment of transitional cell carcinoma of the bladder by many investigators for the substantial risk of distant metastases greater than the rate observed after radical cystectomy. [8] and [9] The reported drawbacks and limitations of this surgical procedure include (a) modified pelvic lymph node dissection to preserve the tissue medial and posterior to the internal iliac artery (presacral tissue), to avoid damage of the nervi erigentes at their origin; (b) preservation of the posterior perivesical tissue and nodes; (c) hematogenous spread of transitional cell carcinoma cells during transurethral resection of the prostate; (d) urethral recurrence due to preservation of the distal part of the prostatic urethra; (e) adenocarcinoma of the prostate left in situ after surgery. Moreover, from a functional point of view, prostate- and seminal-sparing cystectomy has been associated with an increased risk of self-intermittent catheterization for the neobladder outlet obstruction caused by the prostatic tissue.10 Therefore, prostatic invasion by SCC, if present, should be considered only one factor contraindicating prostate- and seminal-sparing cystectomy, and other important limitations exist and should be considered before offering such a procedure to patients with SCC. References 1 A.A. Shokeir Squamous cell carcinoma of the bladder: pathology, diagnosis and treatment BJU Int, 93 (2004), pp. 216–220 View Record in Scopus | Full Text via CrossRef | Cited By in Scopus (51) 2 P.N. Schlegel, P.C. Walsh Neuroanatomical approach to radical cystoprostatectomy with preservation of sexual function J Urol, 138 (1987), pp. 1402–1406 View Record in Scopus | Cited By in Scopus (107) 3 C.D. Zippe, R. Raina, E.Z. Massanyi et al. Sexual function after male radical cystectomy in a sexually active population Urology, 64 (2004), pp. 682–686 4 A. Schilling, A. Friesen Transprostatic selective cystectomy with an ileal bladder Eur Urol, 18 (1990), pp. 253–257 View Record in Scopus | Cited By in Scopus (17) 5 G. Muto, F. Bardari, L. D'Urso et al. Seminal sparing cystectomy and ileocapsuloplasty: long-term follow up results J Urol, 172 (2004), pp. 76–80 Article | PDF (348 K) | View Record in Scopus | Full Text via CrossRef | Cited By in Scopus (52) 6 R. Colombo, R. Bertini, A. Salonia et al. Overall clinical outcomes after nerve and seminal sparing radical cystectomy for the treatment of organ confined bladder cancer J Urol, 171 (2004), pp. 1819–1822 Article | PDF (68 K) | View Record in Scopus | Full Text via CrossRef | Cited By in Scopus (47) 7 M.A. Ghoneim, M.M. El-Mekresh, M.A. El-Baz et al. Radical cystectomy for carcinoma of the bladder: critical evaluation of the results in 1,026 cases J Urol, 158 (1997), pp. 393–399 Article | PDF (723 K) | View Record in Scopus | Full Text via CrossRef | Cited By in Scopus (244) 8 J.P. Stein, R.E. Hautmann, D. Penson et al. Prostate-sparing cystectomy: a review of the oncologic and functional outcomes: contraindicated in patients with bladder cancer Urol Oncol, 27 (2009), pp. 466–472 Article | PDF (186 K) | View Record in Scopus | Full Text via CrossRef | Cited By in Scopus (12) 9 H. Botto, P. Sebe, V. Molinie et al. Prostatic capsule- and seminal-sparing cystectomy for bladder carcinoma: initial results for selected patients BJU Int, 94 (2004), pp. 1021–1025 View Record in Scopus | Full Text via CrossRef | Cited By in Scopus (43) 10 C. Terrone, C. Cracco, R.M. Scarpa et al. Supra-ampullar cystectomy with preservation of sexual function and ileal orthotopic reservoir for bladder tumor: twenty years of experience Eur Urol, 46 (2004), pp. 264–270 Article | PDF (241 K) Full Text via CrossRef Copyright © 2011 Published by Elsevier Inc. Related articles Editorial Comment Urology Editorial Comment The Journal of Urology Defining Patient Selection for Prostate-spar... Urology EDITORIAL COMMENT The Journal of Urology Editorial Comment Urology View more related articles [Table Download] Table Download [MostDownloaded] MostDownloaded [Share] Share Add apps Help Related reference work articles e.g. encyclopedias Skin Cancer, Non-Melanoma Encyclopedia of Cancer (Second Edition) Lids: Anatomy, Pathophysiology, Mucocutaneou... Encyclopedia of the Eye TUMORS, MALIGNANT | Overview Encyclopedia of Respiratory Medicine Bladder Cancer: Assessment and Management Encyclopedia of Cancer (Second Edition) CANCER | Epidemiology of Lung Cancer Encyclopedia of Human Nutrition (Second Edit... More related reference work articles Get Full Text Elsewhere PANGAEA Supplementary Data View Record in Scopus Advertisement Elsevier homepage (opens in a new window) About ScienceDirect About Elsevier Contact and support Information for advertisers Terms and conditions Privacy policy Copyright © 2012 Elsevier B.V. All rights reserved. SciVerse® is a registered trademark of Elsevier Properties S.A., used under license. ScienceDirect® is a registered trademark of Elsevier B.V.

Comment onDefining patient selection for prostate-sparing cystectomy in squamous cell carcinoma of the urinary bladder associated with bilharziasis: an overview of 236 patients / Carini M; Minervini A. - In: UROLOGY. - ISSN 0090-4295. - STAMPA. - 78:(2011), pp. 1354-1355. [doi:10.1016/j.urology.2011.07.1419]

Comment onDefining patient selection for prostate-sparing cystectomy in squamous cell carcinoma of the urinary bladder associated with bilharziasis: an overview of 236 patients.

CARINI, MARCO;MINERVINI, ANDREA
2011

Abstract

Squamous cell carcinoma (SCC) of the urinary bladder, although uncommon in Europe and the United States, is the most common variety of bladder tumor in countries where urinary bilharziasis prevails.1 Radical cystoprostatectomy remains the main treatment, giving a 5-year survival rate of 50%.1 However, because of its effect on sexual function, urinary control, and body image, radical cystectomy is one of the most traumatic cancer operations. Currently, in young patients undergoing radical cystectomy and continent diversion, the primary sources of symptom-induced distress are related to sexual dysfunction (ie, decreased sexual potency, reduced sexual desire, reduced intercourse, and orgasm frequency). The nerve-sparing cystoprostatectomy devised by Schlegel and Walsh2 in 1987 was proposed as an effective technique to preserve erectile function, with an 83% potency rate. However, the reports that followed have shown that even in the best surgical hands, potency maintenance is about 50%.3 To improve patients' quality of life, a technique of prostate-sparing cystectomy after transurethral resection of the prostate was described by Schilling and Friesen4 in 1990. Next, Muto et al5 were the first to report the preservation of a part of the prostate, vasa deferentia, and seminal vesicles to improve, not only postoperative continence, but also potency. Normal erectile function was preserved in 95% of patients, with 100% retrograde ejaculation.5 The results of several studies after these first experiences confirmed the efficacy of this technique in preserving sexual function and its superiority to nerve-sparing radical cystoprostatectomy, even if performed by experts in the field.6 The present report aims to determine risk factors associated with prostate invasion in a large series of patients with SCC of the urinary bladder associated with bilharziasis to define the possible candidates for seminal- and prostate-sparing cystectomy. Prostate infiltration is present in only 5.9% of the patients, probably owing to the prevalent unifocality of SCC associated with bilharziasis, as stated by the authors, and already reported in other series.7 Another interesting point is the high incidence of nodal metastases, present in 29% of patients. The authors conclude that patients with tumors located at bladder neck, >5-cm tumor size, and advanced clinical stage were associated with a greater risk of prostate invasion. Therefore, in such clinical settings, prostate- and seminal-sparing cystectomy should be contraindicated. However, most patients in the present series had nonadvanced SCC, <5 cm, and away from the bladder neck; thus, one might conclude that prostate- and seminal-sparing cystectomy can be safely performed in most patients with SCC. In contrast, prostate- and seminal-sparing cystectomy has been criticized for the treatment of transitional cell carcinoma of the bladder by many investigators for the substantial risk of distant metastases greater than the rate observed after radical cystectomy. [8] and [9] The reported drawbacks and limitations of this surgical procedure include (a) modified pelvic lymph node dissection to preserve the tissue medial and posterior to the internal iliac artery (presacral tissue), to avoid damage of the nervi erigentes at their origin; (b) preservation of the posterior perivesical tissue and nodes; (c) hematogenous spread of transitional cell carcinoma cells during transurethral resection of the prostate; (d) urethral recurrence due to preservation of the distal part of the prostatic urethra; (e) adenocarcinoma of the prostate left in situ after surgery. Moreover, from a functional point of view, prostate- and seminal-sparing cystectomy has been associated with an increased risk of self-intermittent catheterization for the neobladder outlet obstruction caused by the prostatic tissue.10 Therefore, prostatic invasion by SCC, if present, should be considered only one factor contraindicating prostate- and seminal-sparing cystectomy, and other important limitations exist and should be considered before offering such a procedure to patients with SCC. References 1 A.A. Shokeir Squamous cell carcinoma of the bladder: pathology, diagnosis and treatment BJU Int, 93 (2004), pp. 216–220 View Record in Scopus | Full Text via CrossRef | Cited By in Scopus (51) 2 P.N. Schlegel, P.C. Walsh Neuroanatomical approach to radical cystoprostatectomy with preservation of sexual function J Urol, 138 (1987), pp. 1402–1406 View Record in Scopus | Cited By in Scopus (107) 3 C.D. Zippe, R. Raina, E.Z. Massanyi et al. Sexual function after male radical cystectomy in a sexually active population Urology, 64 (2004), pp. 682–686 4 A. Schilling, A. Friesen Transprostatic selective cystectomy with an ileal bladder Eur Urol, 18 (1990), pp. 253–257 View Record in Scopus | Cited By in Scopus (17) 5 G. Muto, F. Bardari, L. D'Urso et al. Seminal sparing cystectomy and ileocapsuloplasty: long-term follow up results J Urol, 172 (2004), pp. 76–80 Article | PDF (348 K) | View Record in Scopus | Full Text via CrossRef | Cited By in Scopus (52) 6 R. Colombo, R. Bertini, A. Salonia et al. Overall clinical outcomes after nerve and seminal sparing radical cystectomy for the treatment of organ confined bladder cancer J Urol, 171 (2004), pp. 1819–1822 Article | PDF (68 K) | View Record in Scopus | Full Text via CrossRef | Cited By in Scopus (47) 7 M.A. Ghoneim, M.M. El-Mekresh, M.A. El-Baz et al. Radical cystectomy for carcinoma of the bladder: critical evaluation of the results in 1,026 cases J Urol, 158 (1997), pp. 393–399 Article | PDF (723 K) | View Record in Scopus | Full Text via CrossRef | Cited By in Scopus (244) 8 J.P. Stein, R.E. Hautmann, D. Penson et al. Prostate-sparing cystectomy: a review of the oncologic and functional outcomes: contraindicated in patients with bladder cancer Urol Oncol, 27 (2009), pp. 466–472 Article | PDF (186 K) | View Record in Scopus | Full Text via CrossRef | Cited By in Scopus (12) 9 H. Botto, P. Sebe, V. Molinie et al. Prostatic capsule- and seminal-sparing cystectomy for bladder carcinoma: initial results for selected patients BJU Int, 94 (2004), pp. 1021–1025 View Record in Scopus | Full Text via CrossRef | Cited By in Scopus (43) 10 C. Terrone, C. Cracco, R.M. Scarpa et al. Supra-ampullar cystectomy with preservation of sexual function and ileal orthotopic reservoir for bladder tumor: twenty years of experience Eur Urol, 46 (2004), pp. 264–270 Article | PDF (241 K) Full Text via CrossRef Copyright © 2011 Published by Elsevier Inc. Related articles Editorial Comment Urology Editorial Comment The Journal of Urology Defining Patient Selection for Prostate-spar... Urology EDITORIAL COMMENT The Journal of Urology Editorial Comment Urology View more related articles [Table Download] Table Download [MostDownloaded] MostDownloaded [Share] Share Add apps Help Related reference work articles e.g. encyclopedias Skin Cancer, Non-Melanoma Encyclopedia of Cancer (Second Edition) Lids: Anatomy, Pathophysiology, Mucocutaneou... Encyclopedia of the Eye TUMORS, MALIGNANT | Overview Encyclopedia of Respiratory Medicine Bladder Cancer: Assessment and Management Encyclopedia of Cancer (Second Edition) CANCER | Epidemiology of Lung Cancer Encyclopedia of Human Nutrition (Second Edit... More related reference work articles Get Full Text Elsewhere PANGAEA Supplementary Data View Record in Scopus Advertisement Elsevier homepage (opens in a new window) About ScienceDirect About Elsevier Contact and support Information for advertisers Terms and conditions Privacy policy Copyright © 2012 Elsevier B.V. All rights reserved. SciVerse® is a registered trademark of Elsevier Properties S.A., used under license. ScienceDirect® is a registered trademark of Elsevier B.V.
2011
78
1354
1355
Carini M; Minervini A
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