ABSTRACT
The exact anatomy and the precise topographic anatomy of the nervi erigents became well established. This technique of nerve sparing radical cystectomy is based on the principle of do not disrupt or interrupt the pathway of the neural fibres of the nervi erigents, that will conform the cavernous nerves. Throughout the steps of this procedure, the integrity of these nerves was protected without compromising the principles of oncologic surgery. Between January 1999 and December 2003, 40 male patients [median age: 50 years, range: 30-67] with stage T[2] bilharzial bladder cancer were treated by this technique of nerve sparing radical cystectomy and urinary diversion at Cairo National Cancer Institute hospital and in the Pyramid hospital at Cairo. The patients were followed up for 3 years after surgery to detect any local or distant recurrence of the disease and to evaluate their potency. Assessment of potency began one month after hospital discharge. All specimens showed a negative prostatic urethral surgical margin. Sixteen [40%] out of 40 patients reported early normal erections to occur in the period from 1 to 6 weeks after hospital discharge. Seventeen patients [42.5%] reported weak unsatisfactory erections and were helped by Sildenafil tablets and gained normal erections and satisfactory sexual activity. Seven [17.5%] out of 40 patients reported no erection to occur up to 12 months after surgery. They were considered to be impotent due to lack of sparing of the neural fibres that supply the corpora cavernosa. The median follow-up period was 53 months [range: 25-84]. For all the forty patients, there were no clinical or radiological evidence of Val or nodal recurrence of the disease. We can conclude that the described modifications of the technique of standard radical cystectony reduced the morbidity of radical cystectomy without altering its therapeutic efficacy