Radical Retropubic Prostatectomy: Bladder Neck Preservation Versus Reconstruction

Poon, Michael W.; Ruckle, Herbert C.; BAMSHAD, B. ROBERT; Tsai, Chris; Webster, Raul; Lui, Paul D.

doi:10.1016/s0022-5347(05)68003-2

Cited by 98 publications

(61 citation statements)

References 21 publications

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“…Shelfo et al [6] studied 365 patients having BN-preserving radical retropubic prostatectomy (RRP) and observed that 88% were continent at 6 months with 7% having a +SM at BN. Poon et al [7] retrospectively studied 101 patients having BN-sparing RRP and compared continence rates with patients having BN reconstruction either with a racket handle repair or an anterior bladder tube reconstruction. High continence rates 6 93% were achieved regardless of the BN approach used.…”

Section: Discussionmentioning

confidence: 99%

Effect of Bladder Neck Preservation during Endoscopic Extraperitoneal Radical Prostatectomy on Urinary Continence

et al. 2010

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Objective: The current study investigates the effect of bladder neck (BN) preservation on postoperative continence and positive surgical margins (+SMs). Patients and Methods: 150 patients (group 1) who underwent BN-sparing endoscopic extraperitoneal radical prostatectomy (EERPE) and 90 patients treated with EERPE and BN resection (group 2) were retrospectively evaluated. Results: Both groups were similar for age, prostate-specific antigen and prostate size. There was no significant difference in operative time, mean blood loss or transfusion rate. Mean catheterization time was similar. The overall +SM rates were very similar at 10.7% for group 1 and 10.0% for group 2 (group 1, pT2 = 5.1% and pT3 = 30.3%; group 2, pT2 = 2.9% and pT3 = 33.3%). One of 16 patients in group 1 and 1 of 9 in group 2 had a +SM at BN. Statistically significant differences in continence were observed 24 h after catheter removal and 3 months postoperatively between both groups. Conclusion: BN preservation proved to have an impact on postoperative early continence of patients undergoing EERPE. Continence of patients who underwent BN preservation was improved after catheter removal and at the 3-month follow-up in comparison to those without BN preservation, but +SMs were not affected by the BN-sparing surgery.

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Section: Discussionmentioning

confidence: 99%

Effect of Bladder Neck Preservation during Endoscopic Extraperitoneal Radical Prostatectomy on Urinary Continence

et al. 2010

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“…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%

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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“…Several other investigators have concentrated on BN preservation as a method to improve postoperative continence, with controversial results regarding the contribution of the technique to both postoperative continence and the oncological outcome. 9,12,22,23 Urethral and BN suspension by various methods (e.g., stitches and slings) has been used in the management of stress incontinence for several years. 24 Walsh and Partin 25 described a technical refinement that divided the dorsal venous complex (DVC) with minimal blood loss while taking care not to injure the striated sphincter.…”

Section: Discussionmentioning

confidence: 99%

Influence of bladder neck suspension stitches on early continence after radical prostatectomy: a prospective randomized study of 180 patients

Stolzenburg

Nicolaus²,

Kallidonis³

et al. 2011

Asian J Androl

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Several techniques have been introduced to improve early postoperative continence. In this study, we evaluated the impact of bladder neck (vesicourethral anastomosis) suspension on the outcome of extraperitoneal endoscopic radical prostatectomy (EERPE). In this research, a total of 180 patients underwent EERPE. Group 1 included patients who underwent nerve-sparing EERPE (nsEERPE) (n545), and Group 2 included patients who underwent nsEERPE with bladder neck suspension (BNS, n545). Groups 3 (n545) and 4 (n545) included patients who received EERPE and EERPE with BNS, respectively. Patients were randomly assigned to receive BNS with their nsEERPE or EERPE procedure. Perioperative parameters were recorded, and continence was evaluated by determining the number and weight of absorbent pads (pad weighing test) on the second day after catheter removal and by a questionnaire 3 months postoperatively. Two days after catheter removal, 11.1% of Group 1, 11.1% of Group 2, 4.4% of Group 3 and 8.9% of Group 4 were continent. The average urine loss was 80.4, 70.1, 325.0 and 291.3 g for the each of these groups, respectively. At 3 months, 76.5% of Group 1 and 81.3% of Group 2 were continent. The continence figures for Group 3 and 4 were 48.5% and 43.8%, respectively. Similar overall rates were observed in all groups. In conclusion, although there are controversial reports in the literature, early continence was never observed to be significantly higher in the BNS groups when compared with the non-BNS groups, regardless of the EERPE technique performed.

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Radical Retropubic Prostatectomy: Bladder Neck Preservation Versus Reconstruction

Abstract: There are no statistically significant differences in return of urinary continence, bladder neck contracture rates or positive margins between bladder neck preservation and excision.

Cited by 98 publications

References 21 publications

Effect of Bladder Neck Preservation during Endoscopic Extraperitoneal Radical Prostatectomy on Urinary Continence

Effect of Bladder Neck Preservation during Endoscopic Extraperitoneal Radical Prostatectomy on Urinary Continence

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

Influence of bladder neck suspension stitches on early continence after radical prostatectomy: a prospective randomized study of 180 patients

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