"Nerve sparing" cystoprostatectomy
Neobladder bladder reconstruction
Surgical treatment of patients with genitourinary malignancies remains a paramount interest of the faculty and staff of the Brady Urological Institute; and that interest extends importantly to patients with all forms of bladder cancer.
Discoveries by Dr. Patrick C.Walsh defined the location of nerves that are responsible for potency in men. Years of surgical research and anatomic studies of the location of these nerves have allowed for the development of a highly emulated technique for "nerve sparing" removal in the male (complete cystoprostatectomy) to permit preservation of potency in patients undergoing major surgery for bladder cancer.
Neuroanatomical approach to radical cystoprostatectomy with preservation of sexual function.
J Urol. 1987 Dec;138(6):1402-6.
The disease-specific survival of men undergoing this types of surgery as well as data on potency after the operation appear below:
Local recurrence and survival following nerve sparing radical cystoprostatectomy for bladder cancer: 10-year followup.
J Urol. 1996 Feb; 155(2):490-4.
Post-operative potency status of 78 evaluable patients listed by pathological stage and age group at time of surgery (no.potent/no.evaluable) |
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| Stage | 20-29 years |
30-39 | 40-49 | 50-59 | 60-69 | 70-79 | Totals |
| PO | - | - | 2/2 | 5/7 | 2/5 | - | 9/14 64% |
| PA | - | - | 1/3 | - | - | 1/3 | 2/6 33% |
| PIS | - | - | 0/1 | 2/5 | 3/10 | 0/1 | 5/17 22% |
| P1 | - | - | 2/3 | 1/4 | 2/6 | - | 5/13 30% |
| P2 | - | - | 2/2 | 1/2 | 1/1 | - | 4/5 80% |
| P3A | 1/1 | - | 1/2 | 1/1 | 0/1 | 0/1 | 2/5 40% |
| P3B | - | - | 0/3 | 1/4 | 2/5 | 1/4 | 5/17 29% |
| P4 | - | - | - | 1/1 | - | - | 1/1 100% |
| Totals | 1/1 100% |
- | 8/16 50% |
12/14 50% |
11/31 35% |
1/6 17% |
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The surgical intervention for invasive bladder cancer is routine and well organized at Johns Hopkins. Complete preoperative consultation, imaging, endoscopic evaluation and expert review of biopsy material and laboratory and x-ray data are accomplished by the faculty and staff of the Institute. All forms of urinary tract reconstruction including ileal-conduit, continent catheterizable and orthoptic neobladder reconstruction are routinely performed at Johns Hopkins.
