Seminal vesicle sparing (SVS) at radical cystectomy (RC) provides good oncologic outcomes and helps to preserve urinary continence and sexual function in well-selected patients with bladder cancer, a new study finds.
Marc A. Furrer, MD, of Bern University Hospital in Bern, Switzerland, and colleagues examined oncologic and functional outcomes from 470 patients who underwent RC during 2000 to 2017. Patients who had tumor within the trigonal area, bladder neck, prostatic urethra, or outside the bladder could not undergo SVS surgery and were previously excluded. For their analysis, the investigators performed propensity score matching and stratified patients into 6 groups according to nerve-sparing and seminal vesicle-sparing status: no sparing at all, unilateral nerve sparing, bilateral nerve sparing, unilateral SVS with unilateral nerve sparing, unilateral SVS with bilateral nerve sparing, and bilateral SVS (with bilateral nerve sparing).
The investigators found favorable oncologic outcomes with any SVS. Progression-free survival and overall survival both were a significant 41% higher for the SVS versus no SVS groups over a median follow-up of 64 months, Dr Furrer’s team reported in The Journal of Urology. Cancer-specific survival sometimes favored SVS. Local recurrence-free survival did not differ significantly among the 6 groups.
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In addition, patients with vs without SVS had significant 12.3-fold increased odds of erectile function recovery, and that pattern continued from 3 months to 5 years after RC. Specifically, the bilateral and unilateral SVS groups had significant 16.8- and 8.6-fold increased odds of erectile function recovery compared with the groups with bilateral or unilateral nerve-sparing only, respectively. SVS was significantly associated with less need for erectile aids. The odds of using erectile aids decreased a significant 9.3-, 9.8-, and 6.8-fold for the groups with any, bilateral, and unilateral SVS compared with no SVS, bilateral nerve-sparing, and unilateral nerve-sparing only, respectively.
Urinary continence rates likewise improved over time for the SVS groups. Less injury probably occurred to the nerves surrounding the tips of the seminal vesicles, according to the investigators. The odds of daytime urinary continence significantly increased 4.7-, 2.6-, and 5.2-fold for the groups with any, bilateral, and unilateral SVS, respectively, compared with no SVS, bilateral nerve-sparing, and unilateral nerve-sparing only, respectively.
“In a highly selected group of patients, [seminal vesicle sparing at RC] is oncologically safe and results in excellent functional outcomes that are achieved at an earlier time point postoperatively and remain superior over a longer time period,” Dr Furrer’s team concluded.
“This study reinforces the concept that a more radical and destructive surgery is not in the interest of all patients, unless dictated by inherent oncological circumstances,” Gianluca Giannarini, MD, of Santa Maria della Misericordia University Hospital in Udine, Italy, and colleagues commented in an accompanying editorial.
References
Furrer MA, Kiss B, Studer UE, et al. Seminal vesical sparing cystectomy for bladder cancer is feasible with good functional results without impairing oncological outcomes: a longitudinal long-term propensity-matched single center study. Published online February 3, 2021. J Urol. doi:10.1097/JU.0000000000001635
Giannarini G, Valotto C, Ficarra V. Editorial comment. Published online February 3, 2021. J Urol. doi:10.1097/JU.0000000000001635.01
