Urethrectomy Is Harmful for Preserving Potency after Radical Cystectomy

Abstract

Twenty-three patients who underwent conventional total cystectomy were examined regarding postoperative potency. Two patients who were subjected to simple cystectomy and whose partial prostate and whole seminal vesicles were left showed full erection and normal ejaculation 1–2 months after surgery, thus giving 100% potency after simple cystectomy. In contrast, of 12 patients who underwent radical cystectomy alone, only 3 (25%) regained potency postoperatively, and the strength and duration of erection were not satisfactory for 1 of the 3 patients. Nine patients who received radical cystectomy and urethrectomy did not show signs of potency postoperatively. The sum total postoperative potency rate in the 21 patients subjected to radical cystectomy was 14.3% (3/21). The facts may indicate that urethrectomy is harmful for postoperative potency because damage of the cavernous nerves probably takes place during surgery. To avoid nerve damage, the urethra should be left intact during radical cystectomy employing the nerve-sparing technique developed by Walsh and Donker unless the posterior urethra is invaded by bladder carcinoma. In addition, it was demonstrated that pelvic irradiation might cause impotency as neither pelvic lymph node dissection nor cisplatin administration had any influence on postoperative potency.

The fate of the urethra after definitive treatment of invasive transitional cell carcinoma of the urinary bladder

“…However, a poor prognosis for symptomatic urethral recurrence has been described in men presenting with a mass or urethral bleeding [ 9] and appropriate surveillance must be conducted for the retained urethra. Urethrectomy at the time of cystectomy appears to be associated with a higher incidence of erectile dysfunction, anorgasmia [ 30–32] and postoperative morbidity. The retained bulbo‐urethral glands with urethral preservation allow some degree of ‘ejaculate’.…”

Urothelial carcinoma in the prostatic urethra and prostate: current controversies

“…Some surgeons have proposed a more liberal use of orthotopic bladder substitution, despite urothelial carcinoma in the prostatic urethra or prostate [36]. In as much as primary cystoprostatourethrectomy is associated with substantially decreased sexual function, the risk of urethral recurrence has to be balanced against the patients opinion and expectations [40,41]. Results of analysis of preoperative resection biopsies from the prostatic urethra can enable a thorough preoperative dialogue with the patient regarding whether to preserve the urethra or not.…”