J. F. Borin, D. W. Skarecky, T. E. Ahlering
University of California, Irvine, Orange, USA

Introduction: We previously reported the benefit of meticulous apical dissection in reducing positive surgical margins (SM+) at the apex (Urology 64:1224, 2004). Herein we assess whether a more aggressive urethral transection will reduce positive margins and if reduced urethral length affects return to continence.

Method: All data was collected prospectively. A positive surgical margin was
defined by the presence of cancer cells with ink on them. Continence, defined as no pads, was assessed via validated questionnaires. Evaluation of 200
consecutive cases (group 1) revealed that 74% of surgical margins occurred at the apex. Concomitantly we assessed visual cues for urethral length which
demonstrated that even patients with very short urethral stumps requiring
perineal pressure during anastomosis had equivalent times to continence as those with long, accessible stumps. We altered the point of urethral transection to include 3-6 mm more of urethra. The SM+ rate and time to continence for the ensuing 100 cases (group 2) was tracked.

Result: The overall SM+ for group 1 was 17.6% versus 6% for group 2
(p=0.006). In group 2 both pT2 and pT3/4 SM+ were reduced (7.3% vs. 2.4%
and 50% vs. 26.7% respectively, both p=0.14). Kaplan-Meier time to continence curves were not significantly different at 3 and 6 months with continence rates of 73% and 89% in group 1 vs. 61% and 95% for group 2.

Conclusion: A more aggressive urethral resection resulted in marked reduction in overall positive surgical margin rates without measurable change in time to continence or overall continence.

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