Urethrectomy is harmful for preserving potency after radical cystectomy.
Twenty-three patients who underwent conventional total cystectomy were examined regarding postoperative potency. Two patients who were subjected to simple cystectomy and whose partial prostate and whole seminal vesicles were left showed full erection and normal ejaculation 1-2 months after surgery, thus giving 100% potency after simple cystectomy. In contrast, of 12 patients who underwent radical cystectomy alone, only 3 (25%) regained potency postoperatively, and the strength and duration of erection were not satisfactory for 1 of the 3 patients. Nine patients who received radical cystectomy and urethrectomy did not show signs of potency postoperatively. The sum total postoperative potency rate in the 21 patients subjected to radical cystectomy was 14.3% (3/21). The facts may indicate that urethrectomy is harmful for postoperative potency because damage of the cavernous nerves probably takes place during surgery. To avoid nerve damage, the urethra should be left intact during radical cystectomy employing the nerve-sparing technique developed by Walsh and Donker unless the posterior urethra is invaded by bladder carcinoma. In addition, it was demonstrated that pelvic irradiation might cause impotency as neither pelvic lymph node dissection nor cisplatin administration had any influence on postoperative potency.