Is “extreme” bladder neck preservation in robot-assisted radical prostatectomy a safe procedure?

Abstract

Introduction: The aim was to investigate the surgical and pathological outcomes of an “extreme” bladder neck preservation in prostate cancer patients treated with robotic radical prostatectomy. The greatest concern about the “extreme” bladder neck preservation is the potential risk of creating a positive surgical margin at the level of bladder neck. Materials and methods: We prospectively collected data from 88 patients with diagnosed prostate cancer who underwent robotic radical prostatectomy with “‘extreme’ bladder neck preservation.” All surgical procedures were performed by the same expert surgeon (F.D.M.). In this study, “‘extreme’ bladder neck preservation” was considered when the length of the spared intraprostatic segment of bladder neck was ⩾1 cm. We compared the histopathologic data with those of a homogeneous similar cohort of 88 consecutive patients who underwent robotic radical prostatectomy without bladder neck preservation. Results: The two groups analyzed were comparable according to clinical and pathological characteristics. A positive surgical margin at the level of bladder neck was found in five (5.7%) cases in the “extreme” bladder neck preservation group and in six cases (6.8%) in the no–bladder neck preservation group. The prostatic base was involved by neoplasia in 14 and 19 patients (15.9% and 21.6%, respectively); of these, five (35.7%) and six (31.6%) had positive surgical margin at the level of bladder neck, respectively. The pathological staging in positive surgical margin at the level of bladder neck patients was pT3 in five (100%) cases in the “extreme” bladder neck preservation group and in four (66.7%) cases when we decided not to preserve the bladder neck. Conclusion: We demonstrated that “extreme” bladder neck preservation is a safe oncological procedure with similar pathologic findings of a comparable no–bladder neck preservation series. Positive surgical margins at the level of bladder neck are linked to neoplasia with adverse pathological features, rather than the “extreme” bladder neck preservation procedure.

Retrotrigonal Layer Dissection from a Posterior Approach Enables Bladder Neck Preservation in Robot-Assisted Radical Prostatectomy

“…While bladder neck preservation might elevate the risk for PSMs, a meta-analysis determined no association between bladder neck preservation and the overall PSM rate or PSM at the prostate base [ 7 ]. In this study, a mere 4% of patients had PSMs at the junction between the prostate and bladder, which aligns closely with findings from previous studies (5.7 to 6.8%) [ 13 ], and none of them experienced an early biochemical recurrence. These suggest that the procedure is likely safe concerning oncological outcomes when selection criteria are judiciously applied.…”

“…The bladder neck preservation technique is one of the methods introduced to facilitate urinary continence through the sparing of the internal sphincter by isolating and dissecting the prostatic urethra [ 13 , 14 , 15 , 16 ]. In contrast, the effect of bladder neck preservation on urinary continence has been controversial [ 17 , 18 ].…”