A new technique of bladder neck reconstruction during radical prostatectomy in patients with prostate cancer

Tolkach, Yuri; Godin, Konstantin; Петров, С. Б.; Schelin, Sonny; Imkamp, Florian

doi:10.1590/s1677-5538.ibju.2014.0341

Cited by 6 publications

(5 citation statements)

References 25 publications

(24 reference statements)

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“…For comparison, 12‐month outcomes in a prospective, population‐based cohort study reported 85% of patients leaking urine less than once a day, and a randomized controlled trial, ProtecT, reported 74% of patients not using pads 18,19 . Case series have generally evaluated short study periods and reported improvements in functional outcomes beyond the status quo after technique changes 20,21 . Our study evaluated whether the benefits reported in such case series and academic forums in the field could be reproduced in a large group of surgeons.…”

Section: Discussionmentioning

confidence: 99%

Have urinary function outcomes after radical prostatectomy improved over the past decade?

Clements

Gmelich

Vertosick

et al. 2021

Cancer

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Background Changes in surgical technique and postoperative care that target improvements in functional outcomes are widespread in the literature. Radical prostatectomy (RP) is one such procedure that has seen multiple advances over the past decade. The objective of this study was to leverage RP as an index case to determine whether practice changes over time produced observable improvements in patient‐reported outcomes. Methods This study analyzed patients undergoing RP by experienced surgeons at a tertiary care center with prospectively maintained patient‐reported outcome data from 2008 to 2019. Four patient‐reported urinary function outcomes at 6 and 12 months after RP were defined with a validated instrument: good urinary function (domain score ≥ 17), no incontinence (0 pads per day), social continence (≤1 pad per day), and severe incontinence (≥3 pads per day). Multivariable logistic regressions evaluated changes in outcomes based on the surgical date. Results Among 3945 patients meeting the inclusion criteria, excellent urinary outcomes were reported throughout the decade but without consistent observable improvements over time. Specifically, there were no improvements in good urinary function at 12 months (P = .087) based on the surgical date, and there were countervailing effects on no incontinence (worsening; P = .005) versus severe incontinence (improving; P = .003). Neither approach (open, laparoscopic, or robotic), nor nerve sparing, nor membranous urethral length mediated changes in outcomes. Conclusions In a decade with multiple advances in surgical and postoperative care, there was evidence of improvements in severe incontinence, but no measurable improvements across 3 other urinary outcomes. Although worsening disease factors could contribute to the stable observed outcomes, a more systematic approach to evaluating techniques and implementing patient selection and postoperative care advances is needed. Lay Summary Although there have been advances in radical prostatectomy over the past decade, consistent observable improvements in postoperative incontinence were not reported by patients. To improve urinary function outcomes beyond the current high standard, the approach to studying innovations in surgical technique needs to be changed, and further development of other aspects of prostatectomy care is needed.

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Section: Discussionmentioning

confidence: 99%

Have urinary function outcomes after radical prostatectomy improved over the past decade?

Clements

Gmelich

Vertosick

et al. 2021

Cancer

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“…Tolkach et al report two methods of BNR-the "standard" technique as well as a modification that they perform. Description of the standard method of the BNR involves eversion of the bladder mucosa and bladder neck narrowing using a running 2-0 absorbable suture from the posterior edge of the bladder neck opening, forming a cross section resembling a "tennis racket" (30,31). The racket handle being the oversewn posterior bladder wall, with the narrowed bladder opening being the racket face.…”

Section: Bladder Neck Reconstruction (Bnr)mentioning

confidence: 99%

“…The racket handle being the oversewn posterior bladder wall, with the narrowed bladder opening being the racket face. A single 2-0 Vicryl ® stitch is then used to approximate the dorsal part of the sphincter complex and the remaining portion of the vesico-prostatic muscle dorsal to the bladder neck (31) deep dorsal stitch, further compresses the bladder neck opening by the surrounding tissues but without reducing the diameter of the orifice (31).…”

Section: Bladder Neck Reconstruction (Bnr)mentioning

confidence: 99%

Open retropubic radical prostatectomy

Pereira¹,

Joshi²,

Roberts³

et al. 2020

Transl Androl Urol

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Radical prostatectomy (RP) is a common treatment choice for localized prostate cancer. While there is increasing utilisation of robotic assisted RP in some centres, open RP (ORP) remains well established and commonly performed in many parts of the world. The goals of modern ORP are to remove the prostate en-bloc with negative surgical margins, while minimising blood loss and preserving urinary continence and erectile function. We present a technical review of ORP incorporating contemporary techniques for control of the deep venous complex, additional haemostatic measures, nerve-sparing and vesicourethral reconstruction.

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“…Abhängig vom intraoperativen Ductus und der Präferenz des Operateurs kommen zur Strikturprävention und Verbesserung des funktionellen Ergebnisses modifizierende Anastomosennaht-Verfahren zum Einsatz. Als technisch einfaches Verfahren sieht die "tennis racket" Blasenhalsrekonstruktion nach Entfernung der Prostata die Eversion der Blasenmukosa und das Einengen der entstandenen Blasenöffnung von dorsal nach ventral mit fortlaufenden Nähten in Form eines Tennisschlägers vor [20]. Weitere Stabilität wird durch einen zusätzlichen Stich nach Rocco, zur Annäherung des dorsalen Anteils des Rhabdosphinkters an den Blasenhals erreicht [21 -23].…”

Section: Blasenhalsstrikturunclassified