Continence outcomes after bladder neck preservation during robot-assisted laparoscopic prostatectomy (RALP) - Abstract

PURPOSE: Urinary incontinence is one of the major prostate cancer treatment-related morbidities.

We review our initial robot-assisted laparoscopic prostatectomy (RALP) experience, focusing on post-surgery continence rates.

MATERIAL AND METHODS: Two-hundred and thirty-three consecutive patients were identified from a prospectively maintained RALP database. A bladder neck sparing dissection was preferentially performed during transperitoneal RALP. On postoperative day 5 or 6 (clinic logistics), the urethral catheter was removed following a normal cystogram.

RESULTS: Median operative time was 190 minutes and estimated blood loss was 75 mL. Three (1.3%) patients required bladder neck reconstruction, while 198 (85.0%) had bilateral, 20 (8.6%) had unilateral and 15 (6.4%) did not undergo nerve sparing prostatectomy. One-hundred and ninety-nine (85.4%) patients had negative surgical margins. Median hospitalization and urethral catheter duration were 1.0 and 5.0 days, respectively. At six weeks, a median 1.0 pad per day usage was reported and mean AUASS and QoL were significantly improved from baseline (p < 0.05). Of the 220 patients having a minimum three-month follow-up, 152 (69.1%) achieved urinary continence without pads. Age, AUASS, QoL, prostate volume and prior TUR surgery independently had significant impact on early continence rate (p < 0.05).

CONCLUSION: A bladder neck sparing dissection allows for early return of urinary continence following RALP without compromising cancer control.

Written by:
Gu X, Araki M, Wong C.   Are you the author?
Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.

Reference: Minim Invasive Ther Allied Technol. 2015 Mar 22:1-8.
doi: 10.3109/13645706.2015.1027711

PubMed Abstract
PMID: 25797687 Prostate Cancer Section