A higher hospital radical cystectomy volume appears to lead to a lower risk of complications only after other common urological oncological procedures, namely radical prostatectomy and nephrectomy, but not after nononcological urology procedures.
This abstract found that hospitals that performed radical cystectomy (removal of the bladder and surrounding tissue for bladder cancer) had less complcations for kidney and prostate cancer surgery as well.
I have been perfoming radical cystecomies my whole career and started perfoming these robotically 3 1/2 years ago. Although I thought performing the more complex surgery helpe me in other surgeries, I didnt realize that a study would show less complications for these other procedures.
Functional results with regard to erectile function and urinary continence after prostate sparing cystectomy are good. Oncological results have been promising, but need to be confirmed after longer followup and in larger trials.
For men in need of a bladder removal for bladder cancer, my practice has always consisted of removing the entire prostate as well. This is what I learned at Indiana and have continued to do in NJ. As far as I know, urologic oncologists in the USA all agree on this.
In Europe I have read several studies that have left the prostate capsule or most of the prostate in place. I think you will see a higher rate of pelvic recurrences and bladder cancer recurrence in the prostate, as well as new prostate cancers this way. I do agree that men will have less side effects in regards to erections and continence potentially.
I have been performing robotic cystectomies for about 3 years now and feel that I can perform a more careful operation around the erection nerves and urinary muscles. I hope to improve on our past results while still removing the entire prostate with the bladder.
UroToday – Robotic vs Open Radical Cystectomy: Prospective Comparison of Perioperative Outcomes and Pathological Measures of Early Oncological Efficacy – Abstract
Robotic-assisted RC appears to offer some operative and perioperative benefits compared with the open approach without compromising pathological measures of early oncological efficacy, such as lymph node yield and margin status. Larger, randomized studies with long-term follow-up are required to confirm these findings and establish oncological equivalence
April has been traditionally a slow month in my practice. Last year it was the only month that I did less than 12 robotic surgeries (I only did 9).
This year I performed 16 robotic surgeries in April.