Oncologic and functional outcomes of sexual-function preserving cystectomy compared with standard radical cystectomy in men: a systematic review

Introduction: Different sexual-function preserving surgical techniques aimed at improving voiding and sexual function in patients undergoing radical cystectomy for bladder cancer have been described. The objective of this systematic review was to determine the effect of sexual function-preserving cystectomy on functional and oncological outcomes.
Materials and Methods: Relevant databases were searched covering the time frame 2000-2015. All publications presenting data on any type of sexual function-preserving cystectomy reporting oncologic and/or functional outcomes with a minimum follow-up of one year were identified. Comparative studies including a minimum of 30 patients and single-arm case series with a minimum of 50 patients were selected. No language restrictions were applied.
Results: Out of 8,517 identified abstracts, 12 studies were eligible for inclusion. Sexual function-preserving cystectomy described included prostate-, capsule-, seminal vesicle and nerve-sparing techniques. Local recurrence ranged from 1.2-61.1% (vs 16.0-55.0% in the control group) and metastatic disease from 0-33.3% (vs 33.0%). No differences were found in comparative studies reporting oncological outcomes. Post-operative potency was significantly better in the sexual function-preserving cystectomy groups in 6 studies comparing sexual function-preserving cystectomy vs radical cystectomy (p<0.05). No major impact on continence was found. Overall, there was moderate to high risk of bias and confounding.
Conclusions: The evidence base for prostate-, capsule- or nerve-sparing cystectomy suggests that these procedures may yield better sexual outcomes than standard cystectomy, without compromising oncological outcomes. However, the overall quality of the evidence was moderate, and hence if offered, patients must be carefully selected, counselled and closely monitored.