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

Abstract

To present the outcomes of robotic radical prostatectomy (RARP) in patients with and without bladder neck sparing. Material and 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 yielded were 13 vs 14 in Groups 1 and 2, respectively (p=0.602). Cystography on postoperative day7, 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). / Öz: Mesane boynu korunan ve korunmayan hastalarda robotik radikal prostatektomi (RARP) sonuçlarının karşılaştırılması. Gereç ve Yöntemler: Tek cerrahın gerçekleştirdiği ve ilk 50 vakanın öğrenme eğrisi nedenli çalışma dışı bırakıldığı ameliyatlar alındı. Grup 1 (mesane boynu korunan, n=141) ve Grup 2 (mesane boynu korunmayan, n=73)’de sırasıyla ortalama hasta yaşı 64.4 ve 65.2 (p=0.396), serum PSA düzeyi 12.1 ve 12.6 (p=0.846), bilateral nörovasküler demet (NVB) koruma 89 (%63.1) ve 53 (%72.6) ve unilateral NVB koruma 32 (%22.6) ve 14 (%19.1) hasta idi. Bulgular: Grup 1 ve 2’de sırasıyla ortalama prostat ağırlığı 56.03 ve 72.9 gr (p=0.001), posterior rabdosfinkter rekonstrüksiyonu (rocco sütürü) oranı %11.3 ve %9.6 (p=0.694), ortalama konsol süresi 154.2 ve 164.3 dakika (p=0.164), intraoperatif kan kaybı 91.8 ve 103.7 cc (p=0.098), hastanede yatış süresi 4.01 ve 4.04 gün (p=0.879), üretral kateter çekim süresi 8.6 ve 9.5 gün (p=0.04), pozitif cerrahi sınır oranı 43 (%30.4) ve 19 (%26.0) (p=0.494), ortalama çıkarılan lenf nodu sayıları 13 ve 14 (p=0.602) idi. Postoperatif 7., 14. ve 21. günlerde sistogramda kaçak olmayan ve üretral kateteri çekilen hasta sayısı sırasıyla Grup 1’de 78 (%66.1), 37 (%31.3) ve 3 (%2.5); Grup 2 de 61 (%83.5), 10 (%13.6) ve 2 (%2.7) idi. En az 1 yıllık takip süresi olan hastalardan (n=185), erken kontinans (sonda çekilmesini takiben kontinan) oranları Grup 1 ve Grup 2 de sırasıyla %58 ve %31 idi (p=0.001). Total kontinan hasta sayısı sırasıyla Grup 1 ve 2’de postoperatif 1. ayda %70 ve %41 (p=0.002); 3. ayda %81 ve %60 (p=0.004); 6. ayda %92 ve %82 (p=0.053) idi. Sonuç: Mesane boynu koruyucu RARP postoperatif erken üriner kontinans kazanılmasında avantaja sahiptir.