Effect of Bladder Neck Preservation on Long-Term Urinary Continence after Robot-Assisted Laparoscopic Prostatectomy: A Systematic Review and Meta-Analysis.

This study aimed to evaluate the effect of bladder neck preservation (BNP) on long-term urinary continence after robot-assisted laparoscopic prostatectomy (RALP). We systematically searched the PubMed, Embase, and Cochrane Library databases to identify studies that assessed the difference in urinary continence and oncologic outcomes between patients who underwent RALP with BNP and those who underwent RALP without BNP. Four trials (1880 cases with BNP, 727 controls without BNP) were considered suitable for meta-analysis. BNP was associated with significantly better urinary continence outcomes at 3-4 months (odds ratio (OR), 2.88; 95% confidence interval (CI), 1.52-5.48; p = 0.001), 12 months (OR, 2.03; 95% CI, 1.10-3.74; p = 0.02), and 24 months (OR, 3.23; 95% CI, 1.13-9.20; p = 0.03) after RALP. There was no difference in the rate of overall positive surgical margin (PSM) (OR, 1.00; 95% CI, 0.72-1.39; p = 0.99) and that of PSM at the prostate base (OR, 0.49; 95% CI, 0.21-1.13; p = 0.09) between the two groups. The BNP technique during RALP leads to early return of urinary continence and long-term urinary continence without compromising the oncologic outcomes.

Journal of clinical medicine. 2019 Nov 24*** epublish ***

Jong Won Kim, Do Kyung Kim, Hyun Kyu Ahn, Hae Do Jung, Joo Yong Lee, Kang Su Cho

Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea., Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul 04401, Korea., Department of Urology, Wonkwang University Sanbon Hospital, Wonkwang University College of Medicine, Gunpo 15865, Korea., Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.