الفهرس 
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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).