IMPACT OF BLADDER NECK PRESERVATION DURING RADICAL PROSTATECTOMY ON CONTINENCE AND CANCER CONTROL

Objectives. To assess the effect of preservation of the bladder neck a nd other factors on the rate of postoperative urinary continence and c ancer control after radical prostatectomy. Methods. Prospective analys is of clinical and pathologic findings in 206 consecutive patients und ergoing radical prostatectomy with a surgical technique that emphasize s preservation of periurethral supporting tissue, urethral length, inc orporation of the posterior periurethral fascia into the vesicourethra l anastomosis, and preservation of the bladder neck. Results. Uni- and multivariate statistical analysis demonstrated that patient age (p = 0.033) and vesical neck contracture (p = 0.047) were predictive of inc omplete return of urinary control. Preservation of the vesical neck ha d no impact on return of continence, but was associated with a trend t o a lower incidence of vesical neck contractures. A positive bladder n eck margin occurred in 6.8% of surgical specimens and was associated w ith a higher grade, more advanced local stage, and other positive marg ins in all cases. The rate of local recurrence or prostate-specific an tigen (PSA)-only failure was similarly independent of whether the vesi cal neck was preserved or resected and reconstructed. Conclusions. Age greater than 65 and occurrence of a vesical neck contracture are adve rse predictors for return of urinary continence after radical prostate ctomy. Preservation of the bladder neck does not have an impact on ret urn of urinary control but may be associated with a lower risk of vesi cal neck contracture. Preservation of the bladder neck does not compro mise cancer control as assessed by local or PSA-only failure rates.