الفهرس 
Neuro anatomy of male sexual functionOnly 14 pages are availabe for public view
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Abstract
is well recognized that radical pelvic surgery is the
most effective from of treatment for certain pelvic cancers,
most mutably carcinoma of the prostate & urinary bladder. It is
well know that fear of impotence after radical cystectomy and
prostatectomy, has resulting in denying many patients benefits
from the operation.
Accordingly, increasing interest has developed in recent
years among urologists as to the preservation of the sexual
function in patients with prostate and bladder cancer.
It should be stressed that the primary goal of surgery is
to remove all tumor; sexuality preservation is of secondary
concern to improve the patient’s quality of life. So, it is
important for all urologists to develop understanding & skill in
this surgical technique which avoids impotence.
This essay was undertaken to review the efficacy of
sexuality preserving radical cystectomy procedure in preserving
sexual function and providing tumor control. Its effects on
continence in this essay some of the important controversies
have been discussed regarding the safety and efficacy of the
sexuality preserving procedures.
The question whether preservation of sexual function
compromises the removal of the tumor can be analyzed in
several ways.
Conclusion
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On the basis of the operative descriptions. Impotence
resulted in the past due to lack of knowledge of the anatomy of
the neurovascular bundles. However, with the good exposure &
knowledge of the anatomy, they can now be excised more
widely when necessary than was previously possible.
Furthermore, evaluation of surgical margins of excision gave no
indication that the potency sexuality preserving procedures
compromise the adequacy of removal cancer.
Modifications to RC that aim to improve quality of life
without compromising oncologic outcomes are a controversial
area among urologic oncologists. Male sexual functionpreserving
RC seeks to preserve the cavernous nerves, vasa
deferentia, seminal vesicles, and prostatic capsule, while
achieving complete cancer clearance. Several European groups
have adopted this strategy for younger patients with organconfined
bladder cancer without bladder neck involvement,
without concomitant prostate cancer, and with good overall
health. However, enthusiasm has been less with regard to this
procedure within the United States.In contrast; nerve-sparing
techniques during open cystoprostatectomy have been used for
at least two decades with reasonable oncologic outcomes.
Nerve-sparing RC for bladder cancer.
Whether open or laparoscopic, must be performed only in
stringently selected patients who have been given a detailed
explanation of the risks and benefits. Although younger patients
and those highly motivated to preserve urinary and sexual
Conclusion
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function may be candidates for this procedure, these are also the
very patients with the longest life expectancy and therefore the
greatest need for long-term cancer cure.
A better understanding of the natural history of
transitional cell carcinoma in female patients and also the
anatomic neurovascular and fascial relationships of the female
rhabdosphincter has facilitated identification of the elements
needed for continent ileal neobladder reconstruction in female
patients. Strict adherence to surgical technique and appropriate
selection of patients will allow for a successful outcome,
although a longer follow-up is necessary.
The key to a successful outcome with orthotopic
diversion in Women is appropriate patient selection and
attention to surgical detail with minimal dissection performed
along the anterior urethra or pelvic floor. An anatomic
understanding of the pelvic anatomy, rhabdosphincter complex,
and corresponding pudendal innervation is important. The
surgical technique to preserve these structures and to optimize
the continence mechanism is critical in the excellent clinical
outcomes seen in women undergoing (SPRC).
Regardless, careful follow-up is mandatory to define the
long term risk of urethral recurrence in these women. Currently,
a pelvic examination with particular attention to the anterior
vaginal wall and voided urine cytology are performed at each
follow-up visit for surveillance purposes of the retained urethra.
Conclusion
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One of the most notable advantages of LRC seems to be
the strikingly small blood loss, with almost negligible
transfusion rates, although it is not consistent in all reports
however, the procedure is difficult to learn and restricted to
those well versed in complex laparoscopic surgery. Sought to
develop a technique for LRC that would use the advantages of
robotic technology and maximize the benefits of the incision
required to remove the bladder.
The recurrence & survival rates were also compared to
that of the standard procedures and the difference was
statistically insignificant.
This essay leads some important conclusions:
1. Modifications in surgical techniques of the radical
cystectomy & prostatectomy operation whether open or
laparoscopic and robot assisted (SPRC) can frequently
prevent impotence. It is possible to perform radical surgery
to cure a patient with invasive bladder cancer and still
maintain continence and sexual function.
2. There is no evidence to suggest that these modifications
compromise the local or distant control of the tumor when
certain criteria are applied appropriately.
3. Potency is maintained in most patients after unilateral wide
excision of the neurovascular bundle.
4. Younger patients were much better than older patients
possibly that patients who were more sexually active
Conclusion
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preoperatively generally have a higher incidence of
satisfactory erectile function postoperatively.
5. The (SPRC) are not replacement of the standard radical
cystectomy.
6. In men with invasive bladder cancer undergoing ( SPRC)
the presence of a primary prostate cancer must be ruled
out, and no extensive secondary involvement of the
prostate gland from the vesical neoplasia.
7. Accurate selection of patients is mandatory to achieve
oncological radicality.
8. In a young, healthy, sexually active woman the benefits of
neurovascular preservation outweigh the risks of longer
operative time and blood loss and strongly recommended.
9- In young men with clinical, superficial bladder tumors
refractory to conservative treatment who wish to maintain
potency and fertility, and to guarantee as good a quality of
life as possible (SPRC) is strongly recommended.
10- Nerve sparing is not only attempted in patients undergoing
ileal orthotopic bladder substitution. Also, patients with
other forms of urinary diversion.