Seminal vesicle-sparing radical prostatectomy: A novel concept to restore early urinary continence

Objectives. Urinary incontinence after radical prostatectomy continues to b e a distressing problem, even with preservation of the neurovascular bundle s and meticulous apical dissection. Recent studies suggest that motor and s ensory components of the pelvic nerve may be affected by surgery, since bot h components are anatomically located in intimate contact with the seminal vesicles. We propose seminal vesicle-sparing radical prostatectomy to prese rve pelvic innervation and improve the rate of urinary continence. Methods. Fifty-four patients were enrolled in this prospective study. A sta ndard retropubic radical prostatectomy was performed in 34 patients. A semi nal vesicle-sparing radical prostatectomy was performed in a pilot series o f 20 consecutive patients. The seminal vesicle tip and surrounding tissue w ere preserved and carefully handled. In all patients, a modified pad test a nd posterior urethral sensory threshold test were performed preoperatively and 6 weeks and 6 months postoperatively and correlated with urinary contin ence. Results. The intraoperative preservation of the seminal vesicle tip was pos sible in all patients in this pilot series (n = 20). In the seminal vesicle -sparing radical prostatectomy group, the continence rate was 60% after 6 w eeks and 95% after 6 months. These rates were significantly higher than the continence rates in the standard prostatectomy group (18% and 82% at 6 wee ks and 6 months, respectively). The sensory threshold levels in the seminal vesicle-sparing group were similar to the preoperative values and were sig nificantly lower than the postoperative threshold levels in the standard pr ostatectomy group. Conclusions. Seminal vesicle tip-sparing radical prostatectomy may be a sur gical option to preserve pelvic innervation and maintain urinary continence after radical prostatectomy. Further randomized studies are necessary to e lucidate the impact of seminal vesicle-sparing radical prostatectomy on res toration of urinary continence. UROLOGY 55: 820-824, 2000. (C) 2000, Elsevi er Science Inc.