Radical laparoscopic prostatectomy: Should we do bladder neck preservation or a reconstruction?

Goeman, Lieven; Salomon, Laurent; Hoznek, Andràs; Taille, Alexandre de la; Vordos, Dimitri; Yiou, R.; Abbou, Clément-Claude

doi:10.1007/s11934-006-0065-2

Cited by 2 publications

(2 citation statements)

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“…Marsh and Lepor prepared a special scale for continence prediction after radical prostatectomy, but until now this tool is useless [7, 8]. The important question is what to do with the bladder neck during radical laparoscopic prostatectomy [9]. …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Bladder neck preservation during classic laparoscopic radical prostatectomy - point of technique and preliminary results.

Chłosta¹,

Drewa²,

Jaskulski³

et al. 2011

Videosurgery and Other Miniinvasive Techniques

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IntroductionStress urinary incontinence after radical prostatectomy for prostate cancer organ-confined patients can significantly affect quality of life. The article presents a technique of bladder neck preservation, because it is believed that this point is one of many crucial points responsible for fast recovery of continence after laparoscopic radical prostatectomy (LRP).Material and methodsLaparoscopic radical prostatectomy with the intention of bladder neck preservation was performed in 194 patients of clinically organ-confined prostate cancer (cT2 ≤ N0M0). The working space was done by tissues-fingers dissections and insufflation of the cavity under full visual control, without the Gaur-balloon device. We insert two 10 mm trocars, three trocars of 5 mm and both 0° and 30° laparoscopes. The most important points of technique include: identification of landmarks of bladder neck and prostate base; dissection of muscle fibres of the very superficial bladder wall; mobilization of the posterior part of the urethra and simultaneous seminal vesicles release; neuro-vascular bundles preservation. This procedure resulted in a long bladder neck which can be easily anastomosed with the urethra. Tension-free and end-to-end (bladder neck-urethra) anastomosis are the results.ResultsIn all cases radical prostatectomy was performed laparoscopically in the extraperitoneal space. There were no complications of bladder neck preservation during laparoscopic radical prostatectomy (LRP) apart from 22 cases with a large medium lobe. The mean time of operation was 150 min (110-210 min). The mean blood loss during LRP was 150 ml (110-350 ml). Blood transfusion was not necessary. There were no postoperative complications. Mean hospitalization time was 5 days. Pathological result of the postoperative specimens was pT2a in 30%, pT2b in 60%, pT3a in 6%, and pT3b in 4% of patients. In 7% of patients a positive surgical margin was affirmed, but the bladder neck was not affected in any case. Full continence after 3, 6, and 12 months was observed in 75%, 85%, and 92% of analysed patients, respectively.ConclusionsBladder neck preservation during LRP is an effective, safe procedure that offers good functional results based on fast recovery of continence. Bladder neck preservation offers full tight anastomosis, especially in cases with no large median lobe of prostatic adenoma. Continence of patients who underwent bladder neck preservation was improved during short-term follow-up. Long-term results are still not conclusive. We think that this technique applied to laparoscopy will finally result in real progress of continence preservation after radical prostatectomy, but larger groups of patients have to be compared.

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Section: Introductionmentioning

confidence: 99%

“…The true urethra-to-urethra anastomosis is the goal of the technique [12]. A few years ago it was stated that all achievements of open procedures and new techniques can be used for developing uro-oncological laparoscopic surgery [9, 13–15]. …”

Section: Introductionmentioning

confidence: 99%