Transprostatic selective cystectomy with an ileal bladder.

Abstract

Since 1987 we have changed our surgical approach to radical cystectomy and ileal neobladder in order to maintain erectile function and urinary continence. The routine diagnostic work-up includes a staging transurethral resection of the prostate in order not to miss any ductal involvement. The selective cystovesiculectomy is performed by cutting through the apex of the prostate, thus leaving a wide, funnel-shaped tunnel of the prostatic urethra for the anastamosis with the M- or W-shaped ileal reservoir. The preliminary results of 27 patients show excellent results concerning erectile function and continence, as requested by our predictive criteria. Especially the continence achieved after a training period of 3 months is reliable. Further observation will show whether the functional improvements and advantages in the operative technique are achieved at the cost of a higher relapse rate of urethral tumors.