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Abstract Urothelial carcinoma is the most common malignancy of the urinary tract and is the second most common cause of death among genitourinary tumors. It accounts for 7% of new cancer cases in men and 2% of new cancer cases in women. The average age at diagnosis is 65 years. At that time, approximately 75% of bladder cancers are localized to the bladder; 25% have spread to regional lymph nodes or distant sites (Badrinath R. Konety et al., 2013). Histologically, 90% of bladder cancers are of urothelial origin, 5% are squamous cell carcinomas, and less than 2% are adenocarcinoma or other variants (Lopez-Beltran, 2008). In Egypt, The incidence of associated bilharziasis decreased from 80% to 50%. A significant increased occurred in transitional cell carcinoma from 20% to 66%, with a significant decrease in squamous cell carcinoma from 73% to 25% (Salem HK et al., 2012). Bladder cancer mortality rates in Egyptian men were relatively high ASR (Age-standardized incidence) = 5.6 per 100 000) although these rates decreased sharply in recent years EAPC (Estimated annual percent change) = –4.0% (Sebastien A et al., 2017). In radical cystectomy series, recurrence occurs in about 30% at 5 years and 40% at 10 years. The incidence of prostatic cancer and prostatic involvement with urothelial cancer in radical cystectomy series is 27-46% and 12-48% respectively (Stein et al., 2009). Radical cystectomy implies removal of the anterior pelvic organs: in men, the bladder with its surrounding fat and peritoneal attachments, the prostate, and the seminal vesicles; in women, the bladder and surrounding fat and peritoneal attachments, cervix, uterus, anterior vaginal vault, urethra, and ovaries. This remains the “gold standard” of treatment for patients with muscle invasive bladder cancer (Badrinath R. Konety et al., 2013). Modified cystectomy is performed in a trial to improve the postoperative continence, potency and sometimes even fertility especially in young patients with bladder cancer (Richards et al., 2010). Chiang et al reported that patients with bladder cancer underwent neo-bladder reconstruction; prostate-sparing cystectomy provides better sexuality Introduction 3 preservation, continence rate, and quality of life (Po Yen Chen and Po Hui Chiang, 2016). Local and systemic recurrence rates after prostate sparing cystectomy is reported in 0–3% of patients in the 11 series in the literature, local recurrence has occurred in 12/369 patients (3.3%) and systemic recurrence in 48/369 (13%).The incidence of synchronous and or metachronous prostate cancer and TCC of the prostatic urethra is lower than that found in conventional cysto-prostatectomy. Recurrence free and overall survival rates are comparable. (Klotz L., 2009). |