Urinary continence and pathological outcome after bladder neck preservation during radical retropubic prostatectomy: A randomized prospective trial

Purpose: Bladder neck preservation during radical prostatectomy has been ad vocated for improving urinary continence. We compared bladder neck preserva tion and resection in a randomized trial, looking at continence rates and s urgical cancer control. Materials and Methods: Patients with stage T1c-T2c prostate cancer underwen t radical retropubic prostatectomy with maximal preservation of the externa l urinary sphincter. Bladder neck preservation or resection was chosen by c hance during surgery. Urinary continence (1 or no protective pad daily) was assessed by interview 2 days after catheter removal, and 2 and 6 months af ter surgery. The surgeon, pathologist and interviewer were the same through out. Neither patient nor interviewer knew which procedure was done. Planned enrollment was 120. Results: Enrollment was stopped after 70 patients because surgical margins were positive only at the bladder neck in 10% of the preservation group but in none of the resection group (p = 0.08). Each group was assigned 35 pati ents but the bladder neck could not be preserved in 4 and 1 died, leaving 3 1 in the preservation group and 38 in the resection group. There were no st atistically significant differences between groups in early or late urinary continence rates. Two days after catheter removal, and 2 and 6 months afte r surgery the respective rates were 79%, 87% and 95% with resection, and 67 %, 87% and 97% with preservation. Conclusions: In our opinion bladder neck preservation during radical retrop ubic prostatectomy does not improve urinary continence and might compromise cancer control. The external sphincter appears more important for continen ce after radical prostatectomy.