Functional and Oncological Outcomes of Genital Sparing Cystectomy in Zagazig University Hospitals

Background: Among malignancies affecting the urinary tract, bladder cancer is the most common and continues to pose significant worldwide health concerns. Objective: To evaluate the functional and oncological outcomes of genital-sparing cystectomy procedures in male patients with bladder cancer. Patients and Methodology: This single-center, prospective study included 50 male patients with contended urothelial carcinoma. Cystoscopy/biopsy with a prostatic urethral biopsy if abnormal was assessed. Based on Clavien–Dindo classification, postoperative complications were assessed and maintained functional and quality of life assessments at defined intervals, alongside oncological follow-up, were performed. Results: The postoperative surgical management included neo-bladder–prostatic re-anastomosis, transurethral resection of the prostate (TURP) with re-anastomosis, and Millin prostatectomy with re-anastomosis. Urinary cytology positivity increased from 0% to 25% in the following 5 years. The ejaculation patterns preoperatively and postoperatively were significantly different: antegrade fell from 90% to 37.5%, retrograde increased; 7.5% reported loss of orgasm, and ART was advised for fertility preservation. Daytime, especially 5 years postoperatively, was slightly incontinent and continue with 5 daytime cases, loss of continence at nighttime significantly worsened. Tumor recurrence increased with follow-up, and was higher with age ≥60, high grade, smoking, and metastasis, while tumor site was not predictive. Late complications included strictures/hydronephrosis, UTIs, stones, neobladder dysfunction continence, retention and oncologic concerns of 5% positive margins plus 45% recurrence at 5 years; sexual complications featured retrograde ejaculation, loss of orgasm, ED, and subfertility. Conclusion: Genital-sparing cystectomy, resulted in positive functional outcomes with respect to sexual function, fertility, urinary continence, and quality of life in male patients post-bladder cancer.