Role of bladder neck preservation in urinary continence following radical retropubic prostatectomy

Selli, Cesare; Antoni, P De; Moro, U; Macchiarella, Angelo; Giannarini, Gianluca; Crisci, Alfonso

doi:10.1080/00365590310017280

Cited by 69 publications

(53 citation statements)

References 23 publications

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“…Additionally, by using the nerve-sparing procedure we improved our continence rates (18), which are possibly attributed to the meticulous dissection of the nerves from the apex of the prostate instead of the preservation of the neurovascular bundle. Furthermore, preservation of the bladder neck especially of its circular fibers, as in this series of patients, contributes to return of continence (19).…”

Section: Commentsmentioning

confidence: 99%

Reducing the number of sutures for vesicourethral anastomosis in radical retropubic prostatectomy

et al. 2009

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Objectives: To prospectively evaluate the outcome of using a two-suture technique for the vesicourethral anastomosis (VUA) during radical retropubic prostatectomy (RRP). Materials and Methods: Two groups of 50 patients each underwent nerve-sparing RRP for localized prostate cancer by one surgeon. In one group, the vesicourethral anastomosis was performed using 2 Vicryl 2-0 stitches placed at the 3-and 9-o'clock positions and in the other group 6 Vicryl 2-0 stitches were placed at the 2-, 4-, 6-, 8-, 10-and 12-o'clock positions. The intraoperative and perioperative parameters analyzed were time to perform the VUA, time to remove the drain and hospitalization. The rate of incontinence, anastomotic stricture and erectile function were included in the outcome analysis. Results: The anastomotic time differed statistically between the 2 groups (mean 3.3 minutes for the 2-suture group and 10.5 minutes for the 6-suture group, p < 0.0001) with similar periods of drain removal (mean 3.12 days for the 2-suture group and 3.45 days for the 6-suture group; p = 0.13) and hospitalization (mean 4.66 days for the 2-suture group and 5.3 days for the 6-suture group; p = 0.09). The functional outcome was excellent for the 2-suture group with no patient suffering from incontinence or anastomotic strictures 1 year postoperatively, while in the 6-suture group there were 2 patients (4%) suffering from incontinence (2 underwent sling procedure) and 1 patient suffered from anastomotic stricture. Conclusion: The low number of sutures in the 2-suture VUA technique reduces operating times, does not influence perioperative and intraoperative parameters and results in excellent functional outcome.

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Section: Commentsmentioning

confidence: 99%

Reducing the number of sutures for vesicourethral anastomosis in radical retropubic prostatectomy

et al. 2009

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“…Selli [15] Bladder neck preservation in RRP leads to faster return of continence but does not affect long-term recovery.…”

Section: Primary Author Resultsmentioning

confidence: 99%

“…Standardization of RALP outcome definitions (such as continence) is imperative before adequate comparisons of these variables can be made. A variety of surgical techniques have been employed in an attempt to improve early return of continence after RP (both open and minimally invasive), including bladder neck (BN) preservation [15,16], intussusception of the BN [17], puboprostatic ligament sparing, sling construction [18], incorporation of the striate urethral sphincter to the anastomosis, and tubularization of the bladder neck. Historically, the actual benefits of these modifications have been somewhat controversial.…”

Section: Urinary Continence and The Urethrovesical Anastomosismentioning

confidence: 99%

Visible Angle on Magnetic Resonance Imaging Can Be Considered Indicator of Postoperative Outcome in Retropubic Radical Prostatectomy

Kwon

Lee

et al. 2017

Korean J Urol Oncol

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Since the introduction of robot-assisted radical prostatectomy (RALP), robotics has become increasingly more commonplace in the armamentarium of the urologic surgeon. Robotic utilization has exploded across surgical disciplines well beyond the fields of urology and prostate surgery. The literature detailing technical steps, comparison of large surgical series, and even robotically focused randomized control trials are available for review. RALP, the first robot-assisted surgical procedure to achieve widespread use, has recently become the primary approach for the surgical management of localized prostate cancer. As a result, surgeons are constantly trying to refine and improve upon current technical aspects of the operation. Recent areas of published modifications include bladder neck anastomosis and reconstruction, bladder drainage, nerve sparing approaches and techniques, and perioperative and postoperative management including penile rehabilitation. In this review, we summarize recent advances in perioperative management and surgical technique for RALP.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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Aim: To investigate the safety, surgical efficiency and patients' ability to recover from urinary continence as a result of a single absorbable running suture versus single-knot running suture for vesicourethral anastomosis (VUA) during laparoscopic radical prostatectomy (LRP). Material and Methods: In a prospective randomised study, we evaluated 162 consecutive patients who underwent LRP with VUA using the single running suture technique or the single-knot running suture technique. Perioperative patients' characteristics, morbidity and urinary continence were analysed. Results: The baseline characteristics were similar between the 2 groups. The single running suture technique was related to decreased anastomotic and total operative times compared with the Van Velthoven technique (13.17 ± 5.74 min vs. 28.49 ± 6.45 min, p = 0.0001, and 174.41 ± 62.97 min and 184.94 ± 46.16 min, p = 0.04, respectively). Overall, urinary continence rates at 3, 6 and 12 months in groups 1 and 2 were 49.4 and 69.1%, 81.5 and 86.4%, and 91.4 and 93.8%, respectively (all with p > 0.05 except the follow-up assessment at 3 months following surgery, p = 0.011). Conclusions: Both methods ensure satisfactory rates of urinary leakage and bladder neck stricture, as well as continence after LRP. However, since the single running suture VUA technique is easier to perform, and the mean anastomosis time of the single running suture VUA technique is shorter than that of the Van Velthoven technique, it appears, therefore, preferable.

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Role of bladder neck preservation in urinary continence following radical retropubic prostatectomy

Cited by 69 publications

References 23 publications

Reducing the number of sutures for vesicourethral anastomosis in radical retropubic prostatectomy

Reducing the number of sutures for vesicourethral anastomosis in radical retropubic prostatectomy

Visible Angle on Magnetic Resonance Imaging Can Be Considered Indicator of Postoperative Outcome in Retropubic Radical Prostatectomy

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

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