Laparoscopic radical prostatectomy with bladder neck preservation: positive surgical margin and urinary continence status.

Abstract

IntroductionPreservation of the bladder neck (BN) has been controversial, as limited excision of the bladder neck may result in incomplete resection of the disease. Moreover, the urinary continence rate may not be improved.AimTo evaluate the effect of bladder neck sparing on urinary continence, and surgical margins status in prostate cancer (PCa) patients treated with laparoscopic radical extraperitoneal prostatectomy.Material and methodsA retrospective analysis of 295 consecutive patients who had undergone laparoscopic radical extraperitoneal prostatectomy for clinically localised prostate cancer in a single institution was performed. Positive surgical margin (SM(+)) and urinary continence status at 3, 6, and 12 months were evaluated.ResultsThe distribution of SM(+) for pT2, pT3, and pT4a was 15.3% (27/176), 49.1% (58/118), and 100% (1/1), respectively. Overall, there were 55.61%, 80.61%, and 84.69% of men continent at 3, 6, and 12 months, respectively. However, when limiting the analysis to those who did not receive adjuvant radiotherapy within 12 months following surgery, urinary continence rates were 59.23%, 85.86%, and 90.21% at 3, 6, and 12 months, respectively. Preoperative prostate-specific antigen (PSA) and pathological T stage were identified as significant predictors of positive surgical margins.ConclusionsConclusions: Laparoscopic radical extraperitoneal prostatectomy with bladder neck preservation has been a safe procedure which has resulted in good functional outcome. We observed a relatively high incidence of positive surgical margins which could be attributed to a large number of extracapsular disease cases.

Single Running Suture versus Single-Knot Running Suture for Vesicourethral Anastomosis in Laparoscopic Radical Prostatectomy: A Prospective Randomised Comparative Study

“…In this study, the overall continence rates in both groups under investigation were comparable with, or better than, the reported in other LRP series [9,10,12,14,21,22,23]. It has to be noted that in this study, we preserved the bladder neck using our own technique in all patients to avoid a potential bias that could have affected the analysis of continence outcomes [13,14].…”

“…It has to be noted that in this study, we preserved the bladder neck using our own technique in all patients to avoid a potential bias that could have affected the analysis of continence outcomes [13,14]. Sparing of bladder neck has been associated with better functional outcomes after surgery due to a lower risk of urethral injury and bladder neck stricture [24,25,26].…”

“…It has been suggested that bladder neck preservation may compromise oncological outcomes by increasing the risk of positive surgical margins. However, we have previously demonstrated that our technique of preserving the bladder neck is oncologically safe and results in good urinary continence rates [14]. …”

“…The pre-study second surgeon's experience included 611 LRP cases, with 203 VUA cases performed using the Van Velthoven method. In all cases, a bladder neck preservation technique was applied with a bladder neck circumference approximating the urethral stump before anastomosis, as previously described [13,14]. …”

Male Stress Urinary Incontinence Following Surgical Intervention: Procedures, Technical Modifications, and Patient Considerations

“…Retrospective studies on bladder neck preservation have confi rmed good functional outcomes, but have also reported high rates (29.2 %) of positive surgical margins in one single center study for bladder neck preserving technique, a concerning fi nding for acceptable oncological control [ 91 ].…”