To spare or not to spare? Bladder neck and robotic radical prostatectomy

Abstract

Aim: To present the outcomes of robotic radical prostatectomy (RARP) in patients with and without bladder neck sparing.

Methods: A single surgeon series of cases after having an experience of >50 procedures were included. Group-1 included patients with bladder neck spared, n=141 and Group-2 included patients with bladder neck not spared, n=73. Mean patient age, preoperative serum PSA, bilateral neurovascular bundle (NVB) sparing and unilateral NVB-sparing were 64.4 versus 65.2 years (p=0.396); 12.1 versus 12.6 ng/ml (p=0.846); 89 (63.1%) versus 53 (72.6%) and 32 (22.6%) versus 14 (19.1%), respectively in Groups 1 and 2.

Results: Mean prostate weights were 56.03 gr and 72.9 gr in Groups 1 and 2, respectively (p=0.001). Rocco suture was performed in 11.3% and 9.6% of Groups 1 and 2, respectively (p=0.694). Mean console time, intraoperative blood loss, duration of hospital stay and urethral catheter removal time in Groups 1 and 2 were 154.2 vs 164.3 min (p=0.164); 91.8 vs 103.7 cc (p=0.098); 4.01 vs 4.04 days (p=0.879) and 8.6 vs 9.5 days (p=0.04), respectively. Positive surgical margin rates were similar (43 (%30.4) vs 19 (%26.0) in both groups (p=0.494). Mean lymph node yield were 13 vs 14 in Groups 1 and 2, respectively (p=0.602). Cystography on postoperative day-7, day-14 and day-21 showed no leakage and urethral catheter was removed in 122 (86.5%), 15 (10.6%) and 4 (2.8%) of Group-1, and 61 (83.5%), 10 (13.6%) and 2 (2.7%) of Group-2, respectively. Of the available 185 patients, following removal of the catheter, immediate continence rate was 58% and 31% in Groups 1 and 2, respectively (p=0.001). On postop 1st-month, 70% and 41% of the patients in Groups 1 and 2, respectively were fully continent (p=0.002). On postop 3rd-month, 81% and 60% of the patients in Groups 1 and 2, respectively were fully continent (p=0.004). On postop 6th-month, 92% and 82% of the patients in Groups 1 and 2, respectively were fully continent (p=0.053).

Conclusion: Bladder neck sparing RARP procedure has an advantage in terms of gaining postoperative early urinary continence.