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The impact of bladder neck sparing on urinary continence during laparoscopic radical prostatectomy; Results from a high volume centre

Ali Serdar Gozen, Yigit Akin, Mutlu Ates, Marcel Fiedler, Jens Rassweiler
  • Ali Serdar Gozen
    Department of Urology, SLK-Klinikum Heilbronn, University of Heidelberg, Heilbronn, Germany | asgozen@yahoo.com
  • Yigit Akin
    Department of Urology, Izmir Katip Celebi University School of Medicine, Izmir, Turkey
  • Mutlu Ates
    Department of Urology, Antalya Teaching and Research Hospital, Antalya, Turkey
  • Marcel Fiedler
    Department of Urology, SLK-Klinikum Heilbronn, University of Heidelberg, Heilbronn, Germany
  • Jens Rassweiler
    Department of Urology, SLK-Klinikum Heilbronn, University of Heidelberg, Heilbronn, Germany

Abstract

Objective: To evaluate the effects of bladder neck reconstruction techniques on early continence after laparoscopic radical prostatectomy (LRP). Materials and methods: This non-randomized retrospective study analyzed prospectively collected data concerning LRP. In total, 3107 patients underwent LRP between March 1999 and December 2016. Exclusion criteria were preoperative urinary incontinence, previous history of external beam radiotherapy, co-morbities which may affect urinary continence such as diabetes mellitus and/or neurogenic disorders, irregular followup, and follow-up shorter than 24 months. All patients were divided into one of three groups, posterior reconstruction being performed in Group 1 (n = 112), anterior reconstruction in Group 2 (n = 762), and bladder neck sparing (BNS) in Group 3 (n = 987). Demographic and pre-, peri-, and postoperative data were collected. Multivariate analyses were performed to determine factors affecting early continence after LRP. Results: 1861 patients were enrolled in the study. The mean follow-up period was 48.12 ± 29.8 months, and subjects’ mean age was 63.6 ± 6.2 years. There was no significant difference among the groups in terms of demographic or preoperative data. Postoperative data, including oncological outcomes, were similar among the groups. The level of early continence was higher in Group 3 than in the other groups (p < 0.001). Multivariate analyses identified BNS and age as parameters significantly affecting early continence levels after LRP (p < 0.001 and p < 0.001, respectively). Bladder neck reconstruction provided less earlier continence than BNS.

Keywords

Bladder neck; Laparoscopy; Surgery; Prostate cancer; Radical prostatectomy; Urinary continence

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Submitted: 2017-05-10 22:05:40
Published: 2017-10-03 09:39:49
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Copyright (c) 2017 Ali Serdar Gozen, Yigit AKIN, Mutlu Ates, Marcel Fiedler, Jens Rassweiler

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