Valutazione prospettica della continenza urinaria nella prostatectomia radicale retropubica bladder neck sparing

Introduction. Urinary incontinence is a major problem in patients undergoing radical retropubic prostatectomy (RRP), the incidence reported in literature being very variable (2-40%). The improvement of post-operative continence should be pursued, although oncological radicality still remains the primary goal of such surgery, and several technical modifications have been proposed for this purpose. This study presents our experience with the bladder neck sparing technique in selected patients with localised prostate cancer. Materials and methods. The study included 20 patients (average age 62 years, range 59-73 years) with localised prostate cancer (clinical stage T1c-T2) subjected to RRP with the bladder neck sparing technique between June 1998 and June 2000. None had previous experience of TURP and none complained of neurological dysfunction of the lower urinary tract. The catheter was removed 13 days after surgery. Average follow-up was 24 months (range 12-36 months). Urinary continence, defined as the need for no more than 1 protective pad daily, was evaluated during interviews at 1, 3, 6, 9, 12 and 18 months after surgery. These results were compared with those obtained in a control group of patients with comparable characteristics (age, clinical stage, PSA, biopsy Gleason score), who had undergone standard RRP performed by the same surgeon. Results. Continence rates, according to our definition, were significantly better in the bladder neck sparing group at 1, 3 and 6 months (25%, 65%, 80% vs. 10%, 40%, 60%), while at 18 months there was no significant difference between the 2 groups. Prostate cancer tissue was found in the bladder neck biopsies in only 1 of 22 patients (4.5%). Oncological follow-up showed biochemical relapse (PSA > 0.3 mg/ml) in 1 patient in each group. Discussion and conclusions. In our experience bladder neck preservation during RRP is technically feasible and contributes substantially to an earlier continence recovery, although it does not improve the long-term results. Moreover, this operation does not compromise the complete eradication of the localised disease compared with the standard technique; on the basis of current data in literature, however, it should be adopted in selected patients.