Impact of bladder neck preservationduring radical prostatectomy on continence and cancer control

Licht, Mark R.; Klein, Eric A.; Tuason, Laurie; Levin, Howard S.

doi:10.1016/s0090-4295(94)80175-4

Cited by 132 publications

(58 citation statements)

References 7 publications

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“…This is consistent with other reports that correlate genuine positive bladder neck margins with poorer prognosis disease -large tumour volume, 6 seminal vesicle invasion 9 and lymph node involvement. 57 As positive bladder neck margins when associated with extracapsular disease coexist with poor prognosis disease, it is unlikely the bladder neck margin affects the overall outcome. What is more, several authors have demonstrated an earlier return to urinary continence 56,58 and reduced incidence of bladder neck contracture.…”

Section: Surgical Techniquementioning

confidence: 99%

“…What is more, several authors have demonstrated an earlier return to urinary continence 56,58 and reduced incidence of bladder neck contracture. 57,75 Other authors have confirmed there is no negative impact on margin status following bladder neck preserving surgery but they have failed to show any significant improvement on return of urinary continence 57 or bladder neck contracture. 59 …”

Section: Surgical Techniquementioning

confidence: 99%

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Avoidance and management of positive surgical margins before, during and after radical prostatectomy

Bott¹,

Kirby

2002

Prostate Cancer Prostatic Dis

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Positive surgical margins after radical prostatectomy lead to an increased risk of progression and reduced disease free survival. Earlier detection of prostate cancer, appropriate patient selection and improved operative techniques can reduce the incidence of positive margins, though the risk can not be eliminated as preoperative staging techniques are not sufficiently sensitive. Nerve sparing and bladder neck sparing do not adversely affect margin status in appropriately selected men. Once positive margins have been diagnosed the optimal management and the timing of treatment remains controversial. Adjuvant radiotherapy or salvage radiotherapy in men with a low PSA may improve local control and PSA free survival in some individuals, a survival benefit has not yet been established.

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Section: Surgical Techniquementioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

Avoidance and management of positive surgical margins before, during and after radical prostatectomy

Bott¹,

Kirby

2002

Prostate Cancer Prostatic Dis

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“…Various surgical techniques have been employed to improve postoperative continence rates [3][4][5][6][7][8]. Many of these are performed in those men who continue to experience significant urinary leakage after the primary surgery [4].…”

Section: Discussionmentioning

confidence: 99%

“…Vesicourethral slings require additional operative time and either the harvesting of fascia or the introduction of a foreign body [5]. Some attempts to preserve sphincteric integrity could result in the compromise of surgical margins [3,6,8].…”

Section: Discussionmentioning

confidence: 99%

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Improved Continence after Radical Retropubic Prostatectomy Using Two Pubo-Urethral Suspension Stitches

et al. 2002

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Objectives: To determine if placement of urethral suspension stitches during radical retropubic prostatectomy improves postoperative urinary continence. Methods: Between January 1997 and January 1998 we performed radical retropubic prostatectomy on 50 men. The first 25 consecutive men had their surgery without urethral suspension stitches while the next 25 received placement of two anastomotic urethral suspension stitches anchored to the lower portion of the pubic bone. Patients were interviewed six months postoperatively and each underwent valsalva leak-point pressure measurement. Patients were categorized as either completely continent (requiring no pads and having no measurable valsalva leak point), socially continent (zero or one pad per day), or incontinent (two or more pads per day). Results: In the urethral suspension group, 8/25 (32%) patients were completely continent and did not have a measurable valsalva leak-point pressure while 3/25 (12%) without urethral suspension were completely continent. Of the remaining patients in the urethral suspension group, 13/17 (76%) patients were socially continent while 4/17 (24%) were incontinent. The mean valsalva leak-point pressure in the 17 patients with suspension stitches was 89.6 ± 21.6 cm H₂O. In the patients without urethral suspension, there were 22 patients who had some degree of incontinence. Among non-stitch patients, 13/22 (59%) were socially continent while 9/22 (41%) were incontinent. The average valsalva leak-point pressure in these patients was 74.0 ± 16.7 cm H₂O, which was significantly lower than those with the suspension (p = 0.015). Conclusion: Placement of anastomotic urethral suspension stitches during radical retropubic prostatectomy may increase the likelihood of complete postoperative urinary continence. The urethral suspension stitches also increase valsalva leak-point pressure, which may improve the percentage of patients with socially acceptable incontinence.

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Prospective assessment of voiding and sexual function after treatment for localized prostate carcinoma

Fulmer

Bissonette

Petroni

et al. 2001

Cancer

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BACKGROUND Voiding and sexual function after treatment are major determinants of quality of life in prostate carcinoma patients. Erectile dysfunction, incontinence, and urinary symptoms, both obstructive and irritative, have a significant negative impact on patient quality of life. This prospective study was undertaken to evaluate voiding, sexual function, and their impact on patients with localized prostate carcinoma who were treated with radical retropubic prostatectomy (RP) and to compare these patients with patients who were undergoing hormonobrachytherapy with external bean radiotherapy (HBTC) and patients who were undergoing hormonobrachytherapy without external beam radiotherapy (HBT). METHODS Patients treated for localized prostate carcinoma with either RP or interstitial palladium‐103 (103Pd) HBTC or HBT were prospectively administered a voiding and sexual function questionnaire before any treatment was initiated and at posttreatment visits. Questionnaire components included the American Urological Association Symptom Score (AUASS) and specific items that addressed urinary control and sexual function from the University of California at Los Angeles Prostate Cancer Index. Questionnaire results were compiled, and differences among treatment groups were assessed over time. RESULTS From January 1997 to November 1999, 127 consecutive patients were treated with either unilateral or bilateral nerve‐sparing RP (42 patients), HBTC (40 patients) or HBT (45 patients) by 2 surgeons proficient in all procedures. Using the overall score and the obstructive subscale (OAUA) of the AUASS, the RP group showed a posttreatment decrease in scores compared with both HBTC and HBT groups. OAUA scores of HBTC and HBT groups were significantly greater than scores in RP patients over the course of the study. HBTC patients had increased irritative symptoms initially when compared with RP patients, and, although not statistically significant, the magnitude of the difference persisted over the course of the study. Total AUASS and subscale scores for the RP group returned to near baseline levels within 12 months. The use of incontinence pads was a criterion for urinary incontinence, and the proportion of patients returning to baseline continence was lower in RP patients over the course of the study. No notable differences in Voiding Bother (VB) scores were found. Initially RP patients experienced worse Sexual Function (SF) scores; however, scores for RP patients changed over time and approached the levels seen in HBTC patients at 18 months. The Sexual Function Bother (SFB) scores also were higher initially in the RP group but then decreased to similar levels observed for HBTC patients by 18 months. None of the treatment groups returned to near baseline SF or SFB scores during the course of this study. CONCLUSIONS Comparison of voiding function indicated that HBTC and HBT patients initially have more obstructive voiding symptoms, whereas urinary incon‐ tinence is initially worse in RP patients. Initially RP patients demonst...

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Impact of bladder neck preservationduring radical prostatectomy on continence and cancer control

Cited by 132 publications

References 7 publications

Avoidance and management of positive surgical margins before, during and after radical prostatectomy

Avoidance and management of positive surgical margins before, during and after radical prostatectomy

Improved Continence after Radical Retropubic Prostatectomy Using Two Pubo-Urethral Suspension Stitches

Prospective assessment of voiding and sexual function after treatment for localized prostate carcinoma

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