SIMPLIFIED URETHRA-BLADDER ANASTOMOSIS AF TER RADICAL PROSTATECTOMY FOR CANCER - A PRELIMINARY COMPARATIVE-STUDY

The authors have done a prospective non randomized study to compare tw o methods of radical retropubic prostatectomy, without bladder neck pr eservation (Group 1 = 30 patients) or with bladder neck preservation ( Group 2 = 15 patients). Anastomosis was simplified for the 15 patients with bladder neck preservation according to the Vest suture procedure . A comparative urodynamical study was performed with each group. Sele ction for one or the other technique was made by the personal choice o r every surgeon. Results were similar for pre operative clinical stagi ng, Gleason score with both groups. There was no significant differenc e in survival, progression of the disease and three month PSA level as those of the last follow-up visit (18-96 months). There was no differ ence between the 2 groups regarding operative time, blood loss, uretha l cathecerization time, drainage output and mean hospitalisation time. The only significant difference was the number of post operative tran fused blood units in the Vest suture group (p < 0,001). There were no positive margin on the preserved bladder neck in group 2, even if ther e was finally an understaging or another apical positive margins. Comp lications were not significantly different in the two groups with 10 b ladder neck strictures in the group 1 (33 %) and only 2 in the group 2 (14,2 %) (NS). Complete continence rate was 73,3 % and 64,2 % respect ively (NS). Bladder neck incision was never followed by incontinence. On urodynamical study, 9 cases in each group were compared and both we re similar but there was a tendancy to a higher urethral pressure in g roup 2; Commets pointed out that bladder neck preservation and simplif ied Vest traction suture did not give more post operative nor carcinol ogical complications than classical technique with direct separate sti ches sutures. Diseas progression, continence and bladder neck strictur e rates were compared to literature, The urodynamical results were the sane as those observed by others studies.