Preservación de cápsula prostática y vesículas seminales en cirugía radical del cáncer vesical órgano confinado

En los ultimos anos se ha incrementado el interes por la preservacion de la capsula prostatica y vesiculas seminales en la cirugia radical del cancer vesical localmente confinado. Las indicaciones para esta tecnica son pacientes jovenes en buenas condiciones, tumores organo confinados, cuello vesical indemne y ausencia de sospecha de cancer prostatico (CP) sincronico. La preservacion semino-prostatica logra mejores resultados postoperatorios en relacion a la continencia, capacidad erectil y eyaculatoria, comparada con la tecnica quirurgica estandar. Nuestro Servicio decidio evaluar esta situacion estudiando en nuestros pacientes sometidos a cistoprostatectomia radical (CPR) por cancer vesical estadio clinico T2, la incidencia de cancer prostatico incidental (CPI) y el compromiso neoplasico de la uretra prostatica. De un total de 17 pacientes sometidos a CPR en nuestro Servicio entre junio de 2002 y abril de 2004 por cancer vesical organo confinado, se seleccionaron 15 casos con estadio pT2- pT3 (edad promedio 64 anos, rango 52-72). Se descarto un paciente por presentar sospecha clinica de cancer de prostata con confirmacion histopatologica a la biopsia por puncion ecodirigida y de la pieza operatoria, y otro paciente en quien se demostro con biopsia preoperatoria, una invasion del tumor vesical transicional a cuello vesical y uretra prostatica. En cada caso seleccionado se estudiaron detenidamente los resultados de la anatomia patologica con especial enfasis en determinar la presencia de un CPI y/o la invasion neoplasica de la uretra prostatica. De los pacientes sometidos a la cirugia radical estandar (n=15), ninguno manifesto sospecha clinica ni serologica de CP previo a la cirugia. Solo en un caso se evidencio un CPI Gleason 3+3 intraglandular en50 por ciento del tejido prostatico (paciente de 63 anos con CPR mas neovejiga ileal ortotopica). Ademas de este caso no se observo ninguna otra neoplasia a nivel prostatico... In the last years the interest for preserving the prostatic capsule and seminal vesicles in the radical surgery for organ confined bladder cancer has increased. The indications for this technique are: young patients in good conditions, organ confined tumors, unharmed bladder neck and no suspicion of a synchronic prostate cancer (PC). Prostate and seminal sparing achieves better results after surgery in regard to continence, erectile and ejaculatory function, compared with the standard surgical technique. Our Department decided to assess this situation in our patients subjected to radical cystoprostatectomy (RCP) for bladder cancer with clinical stage cT2, in regard to the incidence of incidental prostate cancer (IPC) and the tumoral extension to the prostatic urethra. 17 patients were indicated a RCP for organ confined bladder cancer in our Department between June 2002 and April 2004. Of these, 15 cases were identified with stage pT2-pT3 (mean age 64 years, range 52 to 72). Two patients were not included in the series: one patient with clinical suspicion for prostate cancer, (Prostate cancer was then confirmed by ultrasound guided biopsy and final pathology report after surgery), and another patient with verified transitional cell carcinoma invasion to the bladder neck and prostatic urethra. In each selected case the pathological features were carefully studied with special emphasis in determine the presence of a IPC or the tumoral invasion of the prostatic urethra. Any patient with indication of radical surgery (n=15) showed clinical or serological suspicion of PC preoperatively. In only one case, a intraglandular IPC score Gleason 3+3 was demonstrated in 50 percent of the prostatic tissue (63 year old patient with RPC and orthotopic ileal neobladder). Besides this case, no other neoplasia was observed in the prostate, prostatic urethra or seminal vesicles. A 6.6 percent of the RCP of our series presented a IPC...