Korean J Urol.  2012 Jan;53(1):29-33. 10.4111/kju.2012.53.1.29.

Effect of Bladder Neck Preservation and Posterior Urethral Reconstruction during Robot-Assisted Laparoscopic Radical Prostatectomy for Urinary Continence

• You YC
• Kim TH
• Sung GT

• KMID: 1988820
• DOI: http://doi.org/10.4111/kju.2012.53.1.29

Abstract

PURPOSE
To report our results on urinary continence after bladder neck preservation (BNP) and posterior urethral reconstruction (PUR) during robot-assisted laparoscopic radical prostatectomy (RALP).
MATERIALS AND METHODS
Data from 107 patients who underwent RALP were compared on the basis of whether the patients underwent BNP and PUR, BNP only, or the standard technique (ST). In group A (n=31 patients), ST was performed by using Ven velthoven continuous suturing for urethrovesical anastomosis. In group B (n=28 patients), ST with only PUR was performed. In group C (n=48 patients), both the BNP and PUR techniques were used. "Recovery of continence" was defined as the use of 1 pad (50 ml) or less within 24 hours.
RESULTS
The three groups were comparable in terms of patient demographics. The mean operative time and the mean blood loss decreased significantly from group A to group C (p=0.021 for mean operative time and p=0.004 for the mean blood loss). Mean catheterization time was 8.9, 7.8, and 7.1 days in each group (p=0.047). Early return of urinary continence at 3 months was observed in group B (89.2%) and group C (90.6%) compared with group A (71%). However, continence at 6 months was comparable in the 3 groups (87.5% in group A, 92.8% in group B, and 92.3% in group C). Rates of positive surgical margins decreased from 30.2% in group A to 20% in group B and 12% in group C.
CONCLUSIONS
BNP and PUR during RALP showed a favorable impact on the early postoperative recovery of continence while not affecting positive surgical margins.

Keyword

Prostatectomy; Prostatic neoplasms; Urinary incontinence

MeSH Terms

Catheterization
Catheters
Demography
Humans
Neck
Operative Time
Prostatectomy
Prostatic Neoplasms
Urinary Bladder
Urinary Incontinence

Figure

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  FIG. 1 Posterior urethral reconstruction. The posterior urethral reconstruction (PUR) technique requires identification of the posterior portion of the rhabdosphincter and the anterior leaflet of Denovilliers fascia. With the use of one arm of the continuous suture, the posterior part of the rhabdosphincter is anchored with continuous sutures of three to four bites to the remaining portion of the Denovilliers fascia.

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  FIG. 2 Bladder neck preservation technique using lateral bladder neck dissection. The picture shows the left side of the lateral bladder neck dissection. The lateral bladder neck dissection technique requires precise identification of the detrusor muscle fibers at the critical junction of the lateral bladder neck, prostate base, and the fat pad of Whitmore. Meticulous dissection is performed just medially to the fat pad of Whitmore encountering adipose tissue and the lateral border of the bladder neck while appreciating the ventrolateral and dorsal longitudinal muscles until the dissection reaches the prostate base and the anterior surface of the seminal vesicle.

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  FIG. 3 Bladder neck transection. The figure shows a well-preserved bladder neck at the medial aspect between the prostate and the bladder neck.

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