PUBOPROSTATIC LIGAMENT SPARING IMPROVES URINARY CONTINENCE AFTER RADICAL RETROPUBIC PROSTATECTOMY

Objectives. To determine whether a puboprostatic ligament-sparing tech nique of prostatic apical dissection provided improved urinary contine nce after radical retropubic prostatectomy. Methods, A total of 43 men with clinically localized prostate cancer underwent radical retropubi c prostatectomy (standard apical dissection in 25, puboprostatic ligam ent-sparing technique in 18). Patients were evaluated by independent o bserver questionnaire to determine their continence status. The questi onnaire was tested in a control group of 25 men who had not undergone prostate surgery. The overall continence rate and time to achieve cont inence was compared between the two surgical groups. In addition, the clinical and pathologic stages and both the rate and location of posit ive margins were assessed. Results. Mean patient age and serum prostat e-specific antigen values were not significantly different: between th e two groups. Clinical and pathologic stages were also similar. The me an follow-up period for the puboprostatic ligament-sparing group was 3 5 weeks compared with 57 weeks for the standard group (P <0.05). The m edian time until continence was achieved after surgery was significant ly shorter (P = 0.01) for the puboprostatic ligament-sparing group tha n for the standard method (6.5 and 12 weeks, respectively). However, t he overall continence rate at 1-year follow-up for the two groups was similar (100% and 94%, respectively). The positive margin rate and loc ation of positive margins were not different with the puboprostatic li gament-sparing technique. Conclusions. The puboprostatic ligament-spar ing technique improves the rapidity of return of urinary continence af ter radical prostatectomy without significantly enhancing overall cont inence or interfering with the therapeutic efficacy of the procedure. (C) 1998, Elsevier Science Inc. All rights reserved.