Urinary continence after radical retropubic prostatectomy. Analysis and synthesis of contributing factors: a unified concept

Abstract

Objective To assess the eÂects of three types of apicalResults Continence was achieved in 93% overall, with 90%, 93% and 99% achieving continence in Groups dissection on urinary continence after radical retropubic prostatectomy and to evaluate possible contributing 1, 2 and 3, respectively. The mean time to continence was 68 days overall, taking 100, 52 and 30 days for factors, e.g. preservation of the bladder neck and preprostatic sphincter, age, anastomotic strictures, previous the respective groups. Twenty patients (7%) did not achieve full continence; 15 had minor incontinence transurethral resection and nerve-sparing surgery. Patients and methods Having undergone one of three and five severe, with none of the latter being in Group 3. The group (preservation of external sphincter), age types of apical dissection, 280 patients were evaluated: in Group 1 (sphincter-damaging) 134 patients underand freedom from development of anastomotic strictures were the most important factors both in went the original technique of ligating and transecting the venous complex; in Group 2 (sphincter-repairing), regaining continence and decreasing the time to continence. 76 patients had the venous complex with part of striated sphincter incorporated within anastomoticConclusions Preservation of as much as possible of the normal anatomy of the sphincter mechanisms and suture(s); and in Group 3 (sphincter-preserving), 70 patients had the venous complex alone ligated using their nerve supplies results in an excellent return to continence after radical retropubic prostatectomy. the 'bunching' technique of Myers. The outcome was analysed for the number becoming continent and the Keywords Prostatectomy, urinary continence, prostatic neoplasms time to continence. series (as for Group 1, see below); one, after performing

Continence and some properties of the urethral striated muscle of male greyhounds

“…In comparison, in a human infant the striated muscle comprised 79% of the urethra; with increasing age this decreased to 35.5% in an elderly man [6]. This reduction probably explains why the incidence of incontinence after prostatectomy increases with age in men [7].…”

“…In older men there is also reported to be a linear correlation between age and the amount of connective tissue [17]. It has been suggested that the smaller amount of striated muscle in older men is the morphological basis for their higher incidence of urinary incontinence after prostatectomy than in younger men [6,7]. In healthy dogs, 10 years is possibly not long enough to produce such marked changes in the urethra.…”

“…In comparison, in a human infant the striated muscle comprised 79% of the urethra; with increasing age this decreased to 35.5% in an elderly man [6]. This reduction probably explains why the incidence of incontinence after prostatectomy increases with age in men [7].From histochemical studies for the reaction of myo®brillar actomyosin ATPase, striated muscles can be divided into type I (slow twitch), type IIa (fast twitch fatigue-resistant) and type IIb (fast twitch fatiguable) ®bres [8,9]. The type IIb ®bres are absent in the dog but transitional type IIc ®bres (also fast, fatiguable) are present [10].…”

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

“…Initially, the bladder neck preservation was proposed to improve the continence rate after radical prostatectomy, but today there is a general agreement that the preservation of the external sphincter is the most important factor in this purpose [2]. The laparoscopic approach is superior in that way, because it combines a better vision with meticulous hemostasis, allowing for a superior sphinctersparing apical dissection.…”

Accurate Control of the Superficial and Deep Dorsal Veins during Radical Retropubic Prostatectomy: The Münster Clamp Technique

“…This gathering technique should make it easier to find the urethra and to isolate the neurovascular bundles. However, no data on blood loss were provided with this potential improvement of the standard method [5,6].…”