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    Function

    When cancer invades the bladder, treatment often requires removal of the bladder (cystectomy), a man's prostate gland, and other organs involved in erection and ejaculation, rendering him both impotent and infertile. Newer surgical techniques have allowed some men to retain erectile function, but until now surgeons haven't been able to preserve ejaculation and fertility.

    Surgeons at the University of Southern California Los Angeles have reported a method of cystectomy that leaves the prostate, vas deferens, seminal vesicles, and neurovascular bundles-all of which are necessary for ejaculation and fertility-intact. While the new procedure is only appropriate for certain cases, it does give hope to young men with invasive bladder cancer who want to father children.

    The surgeons tried their new technique on four men, ages 24 to 49, with bladder cancer or other pathology that required removal of the bladder but not the entire prostate. While carefully identifying and preserving the nerves, blood vessels, and organs of the reproductive system, they were able to remove the bladder, lymph nodes, and front part of the prostate; connect a reservoir and artificial urethra; and insert a temporary catheter.

    Three weeks after surgery, the catheter was removed. All four men could urinate fully and were continent. The only complication was in one patient who had developed too much mucous and stones in his urinary pouch, which had to be replaced. Kidney function remained normal in all four men throughout the follow-up period of four to 60 months. None of the men had cancer recurrence.

    All four patients were able to achieve erection and ejaculate after the surgery and had normal sperm counts. One man fathered a child a year after surgery. Another man had retrograde ejaculation-the semen went into the artificial bladder instead of out the urethra-but the researchers point out that "semen retrieval from urine is much simpler than … in vitro fertilization."

    In their report in "The Journal of Urology," the surgeons note that this group of men "obviously represents highly select candidates requiring cystectomy," and emphasize that appropriate principles of cancer management are the first priority. In carefully evaluated cases, they conclude, this surgical technique "is an excellent option for men … in whom preservation of continence, potency, and fertility is highly desirable."



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