A comparison of bladder neck preservation and bladder neck reconstruction for urinary incontinence after radical retropubic prostatectomy

Abstract

Background: Prostate cancer is the sixth most common cancer worldwide and will include about 30% of all malignancies in men.Since the initial report of the anatomic radical prostatectomy, refinements in the surgical technique have been made. Several studies showthat bladder neck preservation (BNP) during radical prostatectomy makes improve early return of urinary continence, erectile function or both. However, some clinical trials have suggested little difference between the return of continence while using modifications. In this study, we compared outcomes of BNP and bladder neck reconstruction (BNR) during radical retropubic prostatectomy (RRP).Materials and Methods: This prospective study was performed on 60 patients at a referral university hospital from March 2010 to March 2012. Study population was all patients candidate for RRP (RRP in this period. All patients divided into two groups, A and B (30 patients in each group). Group A (n = 30) who preserved bladder neck (BNP) and Group B (n = 30) who had BNR. Prostate specific antigen (PSA) before and at 2, 6, 9, 12 and18 months after surgery, anastomotic stricture symptoms, positive bladder neck margin, Gleason score and urine incontinence were compared between two groups. Also, we compared bladder neck contracture, urinary continence and positive surgical margin rates after BNP and BNR while retropubic prostatectomy in 24 months period follow-up. Results: The mean age of the patients was 61.81 ± 7.15 years (range, 50-74 years). After a follow-up period of 24 months,the PSA rising was not different between the two groups. After 2 months, 19 (63.33%) of patients in A group and the same number in B group were continent (P = 0.78). Stricture of the bladder neck at the anastomosis site requiring transurethral dilation occurred in 7 (23.33%) and 3 (10.0%) patients in groups A and B, respectively (P = 0.04). Conclusion: Although there was no difference in prevalence and duration of return of urinary continence after the operation between two groups, but results of our study showed that stenosis of the bladder neck was lower in BNP. Hence in the group of BNP, need for further operation and overflow incontinency due to the obstruction of urinary tract will be less likely than BNR and patients have better long time (24 months) urinary continence.

Key words: Bladder neck preservation, bladder neck reconstruction, prostate cancer, prostatectomy, urinary incontinence