TY  - BOOK
AU  - Chou, JiLing
AU  - Dall, Christopher P
AU  - Goldman, Charlotte
AU  - Krasnow, Ross E
AU  - Mason, James
AU  - Stamatakis, Lambros
TI  - Functional and oncologic outcomes of prostate capsule-sparing radical cystectomy: A systematic review and meta-analysis. [Review]
SN  - 1078-1439
PY  - 2024///
KW  - *Erectile Dysfunction
KW  - *Urinary Bladder Neoplasms
KW  - Cystectomy/mt [Methods]
KW  - Erectile Dysfunction/et [Etiology]
KW  - Erectile Dysfunction/su [Surgery]
KW  - Humans
KW  - Male
KW  - Prospective Studies
KW  - Prostate/su [Surgery]
KW  - Retrospective Studies
KW  - Treatment Outcome
KW  - Urinary Bladder Neoplasms/et [Etiology]
KW  - Automated
KW  - MedStar Health Research Institute
KW  - MedStar Washington Hospital Center
KW  - MedStar Georgetown University Hospital/MedStar Washington Hospital Center
KW  - Urology
KW  - Urology Residency - Categorical
KW  - Journal Article
KW  - Meta-Analysis
KW  - Review
KW  - Systematic Review
N2  - Radical cystectomy (RC) is the gold standard treatment for patients with organ-confined bladder cancer. However, despite the success of this treatment, many men who undergo orthotopic neobladder substitution develop significant erectile dysfunction and urinary symptoms, including daytime and nighttime urinary incontinence. Prostate-capsule-sparing radical cystectomy (PCS-RC) with orthotopic neobladder (ONB) has been described in the literature as a surgical technique to improve functional outcomes in appropriately selected patients. We performed a systematic review and meta-analysis of manuscripts on PCS-RC with ONB published after 2000. We included retrospective and prospective studies with more than 25 patients and compared PCS-RC with nerve-sparing or conventional RC. Studies in which the entire prostate was spared (including the transitional zone) were excluded. Comparative studies were analyzed to assess rates of daytime continence, nighttime continence, and satisfactory erectile function in patients undergoing PCS-RC compared with those undergoing conventional RC. Fourteen reports were included in the final review. Our data identify high rates of daytime (83%-97%) and nighttime continence (60%-80%) in patients undergoing PCS-RC with ONB. In comparative studies, meta-analysis results demonstrate no difference in daytime continence (RR:1.12; 95% CI: 0.72-1.73) in those undergoing PCS-RC compared to those undergoing conventional RC. Similarly, nighttime continence was similar between the 2 groups (RR:1.85; 95% CI: 0.57-6.00. Erectile function was improved in those undergoing PCS-RC (RR 5.35; 95% CI: 1.82-15.74) in the PCS-RC series. Bladder cancer margin positivity and recurrence rates were similar to those reported in the literature with conventional RC with an average weighted follow-up of 52.2 months. While several studies utilized different prostate cancer (CaP) screening techniques, the rates of CaP were low (incidence 0.02; 95% CI:0.01-0.04), and oncologic outcomes were similar to standard RC. PCS-RC is associated with improved nighttime continence and erectile function compared to conventional RC techniques. Further work is needed to standardize CaP screening before surgery, but the data suggest low rates of CaP with similar oncologic outcomes when compared to RC. Copyright © 2024 Elsevier Inc. All rights reserved
UR  - https://dx.doi.org/10.1016/j.urolonc.2024.01.008
ER  -