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The location of the bladder neck in postoperative cystography predicts continence convalescence after radical prostatectomy.

ABSTRACT: BACKGROUND:This study was conducted to determine whether the location of the bladder neck in postoperative cystography predicts recovery of continence after radical prostatectomy. METHODS:Between 2008 and 2015, 203 patients who underwent laparoscopic radical prostatectomy (LRP, n?=?99) and robot assisted radical prostatectomy (RARP, n?=?104) were analyzed. The location of the bladder neck was visualized by postoperative routine cystography, and quantitative evaluation of the bladder neck position was performed according to the bladder neck to pubic symphysis (BNPS) ratio proposed by Olgin et al. (J Endourol, 2014). Recovery of continence was defined as no pad use or one security pad per day. To determine the predictive factors for recovery of continence at 1, 3, 6 and 12 months, several parameters were analyzed using logistic regression analysis, including age (?68 vs. >?68, BMI (?23.4 vs. >?23.4 kg/m2), surgical procedure (LRP vs. RARP), prostate volume (?38 vs. >?38 mL), nerve-sparing technique, vesico-urethral anastomosis leakage, and BNPS ratio (?0.59 vs. >?0.59). RESULTS:The mean postoperative follow-up was 1131 days (79-2880). At 1, 3, 6 and 12 months after surgery, continence recovery rates were 25, 53, 68 and 81%, respectively. Although older age (>?68) and RARP were significant risk factors for incontinence within 3 months, neither was significant after 6 months. A high BNPS ratio (>?0.59) was the only significant risk factor for the persistence of incontinence at all observation points, up to 12 months. CONCLUSIONS:A lower bladder neck position after prostatectomy predicts prolonged incontinence.

SUBMITTER: Kageyama S

PROVIDER: S-EPMC5977542 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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The location of the bladder neck in postoperative cystography predicts continence convalescence after radical prostatectomy.

Kageyama Susumu S Yoshida Tetsuya T Nagasawa Masayuki M Kubota Shigehisa S Tomita Keiji K Kobayashi Kenichi K Murai Ryosuke R Tsuru Teruhiko T Hanada Eiki E Johnin Kazuyoshi K Narita Mitsuhiro M Kawauchi Akihiro A

BMC urology 20180530 1

<h4>Background</h4>This study was conducted to determine whether the location of the bladder neck in postoperative cystography predicts recovery of continence after radical prostatectomy.<h4>Methods</h4>Between 2008 and 2015, 203 patients who underwent laparoscopic radical prostatectomy (LRP, n = 99) and robot assisted radical prostatectomy (RARP, n = 104) were analyzed. The location of the bladder neck was visualized by postoperative routine cystography, and quantitative evaluation of the bladd ...[more]

PMID: 29848326

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Project description:BackgroundIntrafascial nerve-sparing prostatectomy has been currently applied based on the updated anatomic understanding of periprostatic cavernous nerves, in order to provide patients better postoperative recovery of continence and potency. The aim of our study is to perform a pooled analysis of available literatures regarding the functional outcomes following intrafascial nerve-sparing technique.MethodsThe authors performed database searches of articles published till October 2017 on PubMed using following keywords across the "title" and "abstract" field of the records: intrafascial, veil, curtain dissection, high anterior release, incremental nerve sparing, and radical prostatectomy. Fulfilled papers were screened and data were extracted independently by 3 reviewers. Main outcome was the postoperative continence and potency rate stratified by follow-up durations. Both 1-arm and comparative meta-analyses were performed and meta-regression models were conducted to evaluate the confounding factors.ResultsUsing the electronic search strategy, a total of 71 records were retrieved and 20 studies were finally included, of which 6 were surgical series and 14 were controlled studies. Our 1-arm meta-analysis summarized the pooled continence rates after intrafascial prostatectomy were 59.4%, 76.2%, 89.9%, and 92.2% at postoperative follow-up of 1, 3, 6, and 12 months, respectively. Regardless of the variance in potency definition, the pooled potency rates after intrafascial prostatectomy were 42.2%, 54.2%, and 72.2% at 3, 6, and 12 months, respectively. Comparative analysis showed that the intrafascial group offered better continence rates at 1, 3, and 6 months with an odds ratio (OR) of 2.38 (95% confidence interval [CI]: 1.73-3.26), 1.82 (95% CI: 1.18-2.82), and 2.19 (95% CI: 1.43-3.34) as compared with the interfascial group. Moreover, potency rate in the intrafascial group was higher at 12 months than in the interfascial group, with an OR of 2.44 (95% CI: 1.35-4.42).ConclusionBased on the limited evidence, our study demonstrated that intrafascial nerve-sparing prostatectomy could provide patients with earlier recovery of continence and better erectile function compared with conventional interfascial approach, but physiological mechanisms about this technique still need further study.

Dataset Information

The location of the bladder neck in postoperative cystography predicts continence convalescence after radical prostatectomy.

Publications

The location of the bladder neck in postoperative cystography predicts continence convalescence after radical prostatectomy.

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