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Thinagaran et al. Mini-invasive Surg 2021;5:46 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2021.53

Systematic Review Open Access

Functional and oncological outcomes with male

nerve sparing robotic assisted radical cystectomy

1
1,2
1
Johnraj Kishore Raja Thinagaran , Fouad Maqboul , Zach Dovey , Peter Wiklund 2
1
Department of Urology, Ashford and St. Peter’s hospital, Chertsey KT16 0PZ, UK.
2
Department of Urology, Mount Sinai Hospital, New York, NY 10029, USA.
Correspondence to: Dr. Zach Dovey, Department of Urology, Icahn School of Medicine, Mount Sinai Hospital, 1, Gustav L. Levy
Place, New York, NY 10029, USA. E-mail: zachary.dovey@mountsinai.org
How to cite this article: Thinagaran JKR, Maqboul F, Dovey Z, Wiklund P. Functional and oncological outcomes with male nerve
sparing robotic assisted radical cystectomy. Mini-invasive Surg 2021;5:46. https://dx.doi.org/10.20517/2574-1225.2021.53

Received: 22 Apr 2021 First Decision: 17 May 2021 Revised: 24 May 2021 Accepted: 26 May 2021 Published: 11 Sep 2021

Academic Editor: Riccardo Autorino Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Aim: In keeping with the ethos of surgical oncology, male nerve sparing (NS) robotic assisted radical cystectomy
(RARC) aims to maximise functional outcomes without sacrificing oncological outcomes. This review details the
surgical technique of male NS RARC as well as discussing strategies that may be employed in tandem with surgery
to improve post-operative recovery and longer-term quality of life.

Methods: An OVID/EMBASE database search was done with key words of robotic, cystectomy, male and nerve
sparing. Publications with no description of post-operative functional outcome were excluded. A total number of 25
relevant publications were selected investigating male NS RARC, assessing functional outcomes along with other
surgical standard indicators.

Results: Most series contained small numbers of patients with largely retrospective data and the associated bias of
selection. Mean follow up of 27.06 months (range 2.8-58 months) was noted overall. Study design, technique,
definitions and measurements of continence and erectile function are heterogeneous across series. With a mean
follow up of 27.06 months (range 2.8-58 months), a post-operative satisfactory erectile function of 54.32% (range
9%-100%) and satisfactory day time continence of 90% (range 54.5%-100%) and night time continence of
80.55% (range 46.7%-88%) was found with a mean positive surgical margin rate of only 1.8% (range 0%-6.4%).

Conclusion: Male NS RARC for appropriately selected patients will offer good functional outcomes. Results from
the series reviewed suggest the technique is both feasible and safe, without compromising longer term oncological
results.

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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