NERVE-SPARING Approaches to Bladder Cancer

Anatomy of the adult male pelvis illustrating the relationship of the neurovascular bundles to the rectum, bladder, and prostate (Reprinted with permission from J. Urol. 138:1402-1406, 1987).

Men with invasive malignant tumors of the bladder often require complete removal of the bladder and prostate. This has always sentenced the patient to lifelong impotence and the need for an external urinary appliance (a bag). However, the technique that we have perfected for radical prostatectomy is equally applicable to radical removal of the bladder and prostate as well.

In a recent review of the results for 25 men who have undergone this procedure over the last five years, 83 percent are potent. Prior to the development of this surgical advance, all patients were impotent. Furthermore, in the last several years we have been able to fashion an artificial bladder from segments of large and small intestine. Dr. Fray Marshall, professor of urology at Johns Hopkins, has perfected this technique. This artificial bladder can be sutured to the urethra in selected patients, enabling them to have normal urinary and sexual function. Once again, a technique developed at Brady has markedly improved the quality of life for men with bladder cancer.