Prostate capsule sparing radical cystectomy – a safe procedure for few

The authors present a four-year experience with prostate capsule sparing (PCS) laparoscopic radical cystectomy (RC) [1]. First, these authors should be commended for their execution of a technically challenging procedure. Although this is a small series, the perioperative outcomes (operative time, blood loss, length of stay (LOS)) are similar to published data for the robotic-assisted procedure [2]. Of note, this paper once again shows that hospital LOS is not shortened with a minimally invasive approach, questioning the benefit to patients (the addition of PSC does not contribute to the perioperative convalescence). The authors present impressive potency (90%) and continence (90% day, 85% night) results, showcasing the quality of life (QOL) benefits of PCS. These numbers are consistent with other centers of excellence [3]. This leaves the oncologic outcomes as the controversial aspect of this procedure. There are two cancers to be considered: urothelial carcinoma of the prostate (UCP) and prostate adenocarcinoma (PC). As the authors point out, local recurrence rates of UCP are low with this technique (none in the present report). Similarly, Mertens et al. found UCP recurrence of <1% in 120 patients undergoing PCS RC [3]. In our opinion, this is the most important aspect of avoiding a total prostate resection. Lest we forget that the basis for en bloc prostate removal is to reduce the amount of urothelium left behind. With strict selection criteria such as that Prostate capsule sparing radical cystectomy – a safe procedure for few