Preserving Urinary and Sexual Dysfunctions After Cystoprostatectomy: Surgical Tips and Tricks

According to the World Health Organization (WHO), bladder cancer is a global disease with almost 600,000 incident cases and 200,000 deaths worldwide. It is considered the tenth most common cancer type worldwide and fourth most common in men and eighth most common in women in Western world countries. Compared to other types of cancers, the tumor of the bladder counts fewer deaths in relation to its incidence. For this reason, bladder cancer has one of the world’s highest prevalence. For the reasons stated above, an early and optimal diagnostic-therapeutic approach is mandatory in order to treat the disease. This must especially concern the non-muscle invasive bladder cancer (NMIBC) which, if not correctly treated and not appropriately followed, may progress, leading to more invasive treatment option such as the radical cystectomy. As known by the literature, radical cystectomy with orthotopic neobladder reconstruction is a feasible option for urinary diversion even though associated with high percentage of significant complications. For this reason, in the past 20 years, many authors have been evaluating different therapeutic approach with the purpose of diminishing the rates of recurrence and progression as well as improving the patients’ quality of life. In this context, the coming of minimally invasive surgical techniques such as the laparoscopic and the latest robotic approach have been trying to help to focus not only on the primary oncological outcomes but also on the functional outcomes. These are mainly determined by achieving urinary continence and sexual function. This chapter describes the main surgical techniques aimed to preserve urinary and sexual functions in patients undergoing radical cystoprostatectomy.