Effect Of Bladder Neck Preservation During Laparoscopic Radical Prostatectomy On Early Urinary Continence

Currently, laparoscopic radical prostatectomy (LRP) represents an established method for the treatment of localized prostate cancer. Stolzenburg et al. have gained more than2400cases treated with LRP since2001and achieved a good result. Urinary incontinence is one of the most common complications after LRP and affects quality of life significantly. How to protect postoperative continence during LRP has gradually become a hot issue. So far, there have been several technical modifications of the LRP procedure in the aspect of continence protection, such as neurovascular bundle, external striated urethral sphincter and puboprostatic ligaments preservation technique as well as energy-free dissection technique. And bladder neck preservation as another modified technique is currently in development.Klein firstly reported that bladder neck preservation can improve urinary continence, and considered that the muscular tissues in bladder neck participate the continence mechanism. In our study, we analysis145cases underwent LRP retrospectively to observe the effect of bladder neck on postoperative continence.Objective:To investigate the effect of bladder neck preservation (BNP) on postoperative continence and the influence on positive surgical margins rate during laparoscopic radical prostatectomy. Methods:From July2006to May2010,145patients with localized prostate cancer (T1b-T2c) underwent laparoscopic radical prostatectomy in our center.59cases (BNP group) treated with bladder neck preservation and86cases (non-BNP group) with bladder neck resection. All cases were confirmed as prostate cancer by transrectal ultrasonography-guided prostate biopsy preoperatively, in which localized tumors were proved by CT or MRI and distant metastases were ruled out by ECT bone scan. All patients were absent of histories of incontinence and radiation therapy preoperatively. All the145operations were performed by the same surgeon. The procedure with absence of repair and reconstruction of the bladder neck and direct suturing of the bladder neck on the urethra was defined as bladder neck preservation. Both procedures of neurovascular bundle preservation and external striated urethral sphincter preservation were carried out on all cases. Positive surgical margins rates were compared between the two groups. Urinary continence was evaluated using the International Continence Society questionnaire at1,3and6months postoperatively, respectively. Postoperative continence was defined as the absence of need for pads or the use of one pad daily for security.Result: At1,3and6months, the urinary continence rates were42.4%,74.6%and86.4%in BNP group respectively, while25.6%,58.1%and80.2%in non-BNP group respectively. Statistically significant differences in continence were observed at1and3months between both groups (P=0.03and P=0.042), while no statistically significant differences were observed at6months postoperatively (P=0.331). The overall positive surgical margins rates were very similar (P=0.954) since10.1%in BNP group and10.4%in non-BNP group. Both groups had one case with positive surgical margins at bladder neck.Conclusion:Bladder neck preservation during laparoscopic radical prostatectomy played a positive role in postoperative early continence while didn’t increase the positive surgical margins rate postoperatively.