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Surgical Innovation in Management of Invasive Bladder Cancer Treatments

Image diagramming the location of the superior vesical pedicle and seminal vesicle

Nerve-sparing Cystoprostatectomy and Neobladder Bladder Reconstruction

Surgical treatment of patients with genitourinary malignancies remains a paramount interest of the faculty and staff of the Brady Urological Institute, and that interest extends importantly to patients with all forms of bladder cancer.

Discoveries by Dr. Patrick C. Walsh defined the location of nerves that are responsible for potency in men. Years of surgical research and anatomic studies of the location of these nerves have allowed for the development of a highly emulated technique for nerve-sparing removal in the male (complete cystoprostatectomy) to permit preservation of potency in patients undergoing major surgery for bladder cancer.

Neurovascular Bundle diagramNeuroanatomical approach to radical cystoprostatectomy with preservation of sexual function. J Urol 1987;138(6):1402-1406.

The disease-specific survival of men undergoing this type of surgery as well as data on potency after the operation appear below:

Johns Hopkins Hospital disease specific survival rates

Local recurrence and survival following nerve sparing radical cystoprostatectomy for bladder cancer: 10-year follow-up. J Urol 1996;155(2):490-494.

Postoperative potency status of 78 evaluable patients listed by pathological stage and age group at time of surgery (No. potent/No. evaluable)
PO--2/25/72/5-9/14      64%
PA--1/3--1/32/6      33%
PIS--0/12/53/100/15/17      22%
P1--2/31/42/6-5/13      30%
P2--2/21/21/1-4/5      80%
P3A1/1-1/21/10/10/12/5      40%
P3B--0/31/42/51/45/17      29%
P4---1/1--1/1      100%

The surgical intervention for invasive bladder cancer is routine and well organized at Johns Hopkins. Complete preoperative consultation, imaging, endoscopic evaluation and expert review of biopsy material, laboratory, and X-ray data are accomplished by the faculty and staff of the institute. All forms of urinary tract reconstruction, including ileal-conduit, continent catheterizable and orthotopic neobladder reconstruction, are routinely performed at Johns Hopkins.

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