Functional and oncological outcomes with male nerve sparing robotic assisted radical cystectomy

Abstract

Aim: In keeping with the ethos of surgical oncology, male nerve sparing (NS) robotic assisted radical cystectomy (RARC) aims to maximise functional outcomes without sacrificing oncological outcomes. This review details the surgical technique of male NS RARC as well as discussing strategies that may be employed in tandem with surgery to improve post-operative recovery and longer-term quality of life.

Methods: An OVID/EMBASE database search was done with key words of robotic, cystectomy, male and nerve sparing. Publications with no description of post-operative functional outcome were excluded. A total number of 25 relevant publications were selected investigating male NS RARC, assessing functional outcomes along with other surgical standard indicators.

Results: Most series contained small numbers of patients with largely retrospective data and the associated bias of selection. Mean follow up of 27.06 months (range 2.8-58 months) was noted overall. Study design, technique, definitions and measurements of continence and erectile function are heterogeneous across series. With a mean follow up of 27.06 months (range 2.8-58 months), a post-operative satisfactory erectile function of 54.32% (range 9%-100%) and satisfactory day time continence of 90% (range 54.5%-100%) and night time continence of 80.55% (range 46.7%-88%) was found with a mean positive surgical margin rate of only 1.8% (range 0%-6.4%).

Conclusion: Male NS RARC for appropriately selected patients will offer good functional outcomes. Results from the series reviewed suggest the technique is both feasible and safe, without compromising longer term oncological results.

Keywords

Nerve-sparing / robotic / cystectomy / functional outcomes / continence / erection

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