Radical cystectomy is a demanding procedure, associated with mortality and considerable morbidity and permanent changes in urinary and sexual function with consequent effects on mental and psychological wellbeing. Of fundamental importance is the honest pre-operative information given to the patient and, preferably, also to the partner, about the planned procedure and its consequences. Alternative methods that might be applicable for reconstruction should be described, including those of which the urologist has little or no experience. Withholding such information because referral of the patient may be necessary is an abomination and must not occur.
Consulting with the patient twice before surgery is the minimal requirement. It is important that the patient is made fully aware of all the facts, especially of disadvantages with specific procedures, like risk of incontinence, need of self-catheterization, etc. To have the patient meet a patient with the type of reconstruction planned will allow for an optimal understanding of how the 'new' urinary tract will work. Possible changes in sexual function should be described to the patient and to the partner. Preserved erectile potency is reported in 10-80% of cases after cystoprostatectomy.4,5 In our experience, the vast majority of patients are impotent. We do not routinely perform nerve-sparing cystoprostatectomy
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