Radical retropubic prostatectomy: Bladder neck preservation versus reconstruction

Purpose: We compare bladder neck contracture, urinary continence and positi ve surgical margin rates after bladder neck preservation and excision with radical retropubic prostatectomy, Materials and Methods: A retrospective analysis of clinical and pathologica l findings, and followup of 220 patients who underwent radical retropubic p rostatectomy was performed. Patients were divided into 3 groups of bladder neck preservation (101), "tennis racket" reconstruction (63) and anterior b ladder tube reconstruction (56), Results: Mean followup was 19.7, 36.7 and 16.2 months, respectively, for bl adder neck preservation, tennis racket reconstruction and anterior bladder tube reconstruction, Overall, bladder neck contracture occurred in 22 of 22 0 cases (10%), including 5 of 101 (5%) with bladder neck preservation, 7 of 63 (11%) with tennis racket reconstruction and 10 of 56 (18%) with anterio r bladder tube reconstruction, which approached statistical significance (p = 0.061). Urinary continence was assessed by a third party telephone inter view of 165 patients. Continence rates at 1 year were 93% for bladder neck preservation, 96% for tennis racket reconstruction and 97% for anterior bla dder tube reconstruction, which was not statistically significant (p = 0.68 ). Positive margin rates were 27.4% with bladder neck preservation versus 3 0.5% with excision, which was not significantly different. Conclusions: There are no statistically significant differences in return o f urinary continence, bladder neck contracture rates or positive margins be tween bladder neck preservation and excision.