Anterograde release of the neurovascular bundle during nerve-sparing robot-assisted radical cystectomy: initial experience and functional outcomes in males from a case-series.

Background: Sexual function in males after robot-assisted radical cystectomy (RARC) is often impaired. We propose a technical modification for anterograde release of the neurovascular bundle during RARC to improve functional outcomes. Case Description: In this study, we constructed a standard operative procedure to preserve the neurovascular bundle (NVB) during the RARC, and 5 consecutive patients underwent modified RARC performed by a single surgeon. Using the developed posterior prostatic capsule as a guide, anterograde release of the NVB began at the base of the prostate to the apex without suturing the dorsal vascular complex. Potency was defined as a Sexual Health Inventory for Men (SHIM) score ≥17. The median age of the patients was 64 years. No positive surgical margin was reported. One patient was postoperatively diagnosed as pT2N1 and received adjuvant chemotherapy. After a median follow-up time of 11 (range, 10-15) months, no radiographic recurrence was reported. Only the patient diagnosed as pT2N1 was considered impotent (an SHIM <17). One patient started Tadalafil usage at 4 weeks after surgery and achieved potency 1 week later. The other 3 patients recovered their potency spontaneously in 4-8 weeks. Limitations of this study are that it was a noncomparative study and with relatively low sample size. Conclusions: Anterograde release of NVB during RARC is a method with high versatility and achieves promising functional outcomes for selected bladder cancer patients in our preliminary experience. Further controlled studies are needed to confirm these findings.