Bladder neck preservation improves time to continence after radical prostatectomy: a systematic review and meta-analysis

Ma, Xueyou; Tang, Kun; Yang, Chunguang; Wu, Guanqing; Xu, Nan; Wang, Meng; Zeng, Xing; Hu, Zhiquan; Song, Ranran; Yuh, Bertram; Wang, Zhihua; Ye, Zhangqun

doi:10.18632/oncotarget.11997

Cited by 64 publications

(45 citation statements)

References 56 publications

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“…A previous systematic review and meta-analysis of 13 studies assessing bladder neck sparing (BNS) versus non-BNS techniques reported improved early and long-term recovery of urinary continence without negatively affecting oncological control. Their results were yet non-conclusive given the limitations of the studies included, and the authors suggest the need for further large, prospective, multicentre, long-term follow-up studies and RTCs to confirm them [ 25 ]. Here, we perform a critical review of the available data localising positive surgical margins after bladder neck sparing radical prostatectomy.…”

Section: Introductionmentioning

confidence: 99%

Systematic Review of Studies Reporting Positive Surgical Margins After Bladder Neck Sparing Radical Prostatectomy

et al. 2017

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Purpose of ReviewBladder neck preservation (BNP) during radical prostatectomy (RP) has been proposed as a method to improve early recovery of urinary continence after radical prostatectomy. However, there is concern over a possible increase in the risk of positive surgical margins and prostate cancer recurrence rate. A recent systematic review and meta-analysis reported improved early recovery and overall long-term urinary continence without compromising oncologic control. The aim of our study was to perform a critical review of the literature to assess the impact on bladder neck and base margins after bladder neck sparing radical prostatectomy.Evidence AcquisitionWe carried out a systematic review of the literature using Pubmed, Scopus and Cochrane library databases in May 2017 using medical subject headings and free-text protocol according to PRISMA guidelines. We used the following search terms: bladder neck preservation, prostate cancer, radical prostatectomy and surgical margins. Studies focusing on positive surgical margins (PSM) in bladder neck sparing RP pertinent to the objective of this review were included.Evidence SynthesisOverall, we found 15 relevant studies reporting overall and site-specific positive surgical margins rate after bladder neck sparing radical prostatectomy. This included two RCTs, seven prospective comparative studies, two retrospective comparative studies and four case series. All studies were published between 1993 and 2015 with sample sizes ranging between 50 and 1067. Surgical approaches included open, laparoscopic and robot-assisted radical prostatectomy. The overall and base-specific PSM rates ranged between 7–36% and 0–16.3%, respectively. Mean base PSM was 4.9% in those patients where bladder neck sparing was performed, but only 1.85% in those without sparing.SummaryBladder neck preservation during radical prostatectomy may increase base-positive margins. Further studies are needed to better investigate the impact of this technique on oncological outcomes. A future paradigm could include modification of intended approach to bladder neck dissection when anterior base lesions are identified on pre-operative MRI.

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Section: Introductionmentioning

confidence: 99%

Systematic Review of Studies Reporting Positive Surgical Margins After Bladder Neck Sparing Radical Prostatectomy

et al. 2017

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“…Bladder neck preservation improved early (6 months) continence rates and long-term (>12 months) continence rates. 33 Anastomotic leak rates, positive surgical margins, and biochemical failure rates were comparable between the two groups. More recently, Rajih et al 34 assessed 322 men who underwent robot-assisted RP in Canada, demonstrating that bladder neck preservation (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.5-0.99; P = 0.04), and prostate size (HR, 0.99; 95% CI, 0.98-0.99; P = 0.02) were independent predictors of continence recovery after surgery.…”

Section: Preservation Techniquesmentioning

confidence: 80%

“…A systematic review and meta‐analysis evaluated 13 trials, including two RCTs, six prospective, and five retrospective studies. Bladder neck preservation improved early (6 months) continence rates and long‐term (>12 months) continence rates . Anastomotic leak rates, positive surgical margins, and biochemical failure rates were comparable between the two groups.…”

Section: Peroperative Measures In the Prevention Of Uimentioning

confidence: 86%

How can we prevent postprostatectomy urinary incontinence by patient selection, and by preoperative, peroperative, and postoperative measures? International Consultation on Incontinence‐Research Society 2018

Averbeck

Marcelissen

Anding

et al. 2019

Neurourology and Urodynamics

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Aims: To review current prevention strategies for urinary incontinence among patients undergoing radical prostatectomy (RP). Methods: This is a consensus report of the proceedings of a research proposal from the annual International Consultation on Incontinence-Research Society (ICI-RS), 14 to 16 June 2018 (Bristol, UK): "How can we prevent postprostatectomy incontinence by patient selection, and by preoperative, peroperative, and postoperative measures?" Results: Several baseline parameters were proposed as predicting factors for postprostatectomy urinary incontinence (PPUI), including age, tumor stage, prostate volume, preoperative lower urinary tract symptoms, maximum urethral closure pressure, and previous transurethral resection of the prostate.More recently, magnetic resonance imaging has been used to measure the membranous urethral length and sphincter volume. Peroperative techniques include preservative and reconstructive approaches. Bladder neck preservation improved early (6 months), as well as long-term (>12 months) continence rates.Several prospective studies have reported earlier return of continence following preservation of puboprostatic ligaments, although no long-term data are available. Preservation of the urethral length yielded controversial outcomes.Concerning postoperative strategies, it is probably optimal to remove the catheter in a window between 4 and 7 days if clinically appropriate; however, more research in this regard is still required. Postoperative PFME (preoperative pelvic floor muscle exercise) appears to speed up the recovery of continence after RP.Conclusions: Conservative strategies to prevent PPUI include proper patient selection and PFME. Peroperative techniques have largely shown benefit in the short term. Postoperative complications and timing of trial without catheter can influence continence status. Future research initiatives must assess peroperative and postoperative measures, with longer-term follow-up.

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“…Preservation of puboprostatic ligament improves the rapidity of urinary continence after radical prostatectomy . Other criteria such as a bladder neck preservation, an intussusception of the reconstructed bladder neck, or preservation of the normal urethral sphincter anatomy improve time to continence after radical prostatectomy. Thus, all of these factors may contribute to SUI after radical prostatectomy.…”

Section: Introductionmentioning

confidence: 99%

Effect of radical prostatectomy on involuntary pelvic floor muscle contraction

Gerbaud

Charlanes

Chesnel

et al. 2019

Neurourology and Urodynamics

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Aims Radical prostatectomy may cause stress urinary incontinence (SUI). We compared continent and incontinent men after radical prostatectomy, in regard to the change of the temporal pattern of pelvic floor activation during cough. Methods Twenty‐two patients were included in this prospective, multicentric study. All patients gave their informed consent. Simultaneous recordings of electromyographic activity of external anal sphincter (EAS EMG) and external intercostal muscle (EIC EMG) during cough were performed with a pair of pregelled surface electrodes. Cough effort caused an involuntary pelvic contraction. Intercostal muscles recording was chosen because they are one of the muscular components of cough initiation with diaphragm muscle. Twenty‐four‐hour pad‐weighing test was used to quantify urinary incontinence. The primary endpoint was the latency between the onset of EIC EMG and EAS EMG (RT3), during a cough effort. We also measured the contraction time, the maximum EAS EMG activity, and the area under the curve. Results All the patients were analyzed: 12 continent and 10 with SUI. The median age was 66 years old. Both groups were similar except in term of follow‐up. Median latency was increased by −1.7 ms (−47.9; +34.2) to 55.8 ms (+47.5; +80) in patients with SUI (P = 0.0033; Table 2). The duration of the contraction, the maximum EAS EMG activity and the area under the curve were not different. Conclusions The latency between the onset of EIC EMG and EAS EMG is increased in patients with SUI after radical prostatectomy. It may be one of the reasons for SUI in these patients.

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Bladder neck preservation improves time to continence after radical prostatectomy: a systematic review and meta-analysis

Cited by 64 publications

References 56 publications

Systematic Review of Studies Reporting Positive Surgical Margins After Bladder Neck Sparing Radical Prostatectomy

Systematic Review of Studies Reporting Positive Surgical Margins After Bladder Neck Sparing Radical Prostatectomy

How can we prevent postprostatectomy urinary incontinence by patient selection, and by preoperative, peroperative, and postoperative measures? International Consultation on Incontinence‐Research Society 2018

Effect of radical prostatectomy on involuntary pelvic floor muscle contraction

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