The Impact of Lateral Bladder Neck Preservation on Urinary Continence Recovery After Robot-Assisted Radical Prostatectomy

• Published in: Journal of endourology Vol. 32; no. 1; p. 40
• Main Authors: Hashimoto, Takeshi, Yoshioka, Kunihiko, Gondo, Tatsuo, Hasama, Kazuki, Hirasawa, Yosuke, Nakashima, Jun, Tachibana, Masaaki, Ohno, Yoshio
• Format: Journal Article
• Language: English
• Published: United States 01.01.2018
• Subjects: Aged; Clinical Competence; Humans; Male; Middle Aged; Multivariate Analysis; Organ Sparing Treatments - methods; Prostatectomy - adverse effects; Prostatectomy - methods; Recovery of Function - physiology; Retrospective Studies; Risk Factors; Robotic Surgical Procedures; Urinary Bladder - surgery; Urinary Incontinence - etiology; Urinary Incontinence - prevention & control; robot-assisted radical prostatectomy; urinary continence recovery; bladder neck preservation
• ISSN: 1557-900X
• DOI: 10.1089/end.2017.0459

Urinary incontinence is one of the most bothersome adversities after robot-assisted radical prostatectomy (RARP). The aim of this study was to investigate the urinary continence recovery and the effect of various surgical techniques. We previously reported that posterior rhabdosphincter reconstruction and nerve-sparing were independent predictors of urinary continence recovery 1 month after catheter removal in 199 patients who underwent RARP. Retrospectively, we further reviewed those 199 patients for urinary continence recovery at 3 months or later after RARP. The relationships of urinary continence with perioperative findings, including surgical procedures, were evaluated at 3 to 12 months after RARP. The Fisher exact test and Mann-Whitney rank sum test were used for evaluating variables between the groups. Multivariate logistic regression analysis was performed to investigate the association between urinary continence and perioperative factors. On univariate analyses, surgeon experience, lateral bladder neck preservation (BNP), anterior reconstruction, and posterior reconstruction were significantly associated with urinary continence recovery 3 months after RARP, but only lateral BNP was independently associated with urinary continence recovery in a multivariate analysis. Similarly, on univariate analyses, surgeon experience, lateral BNP, and posterior reconstruction were significantly associated with continence recovery at 6 months or later after surgery. However, multivariate analyses showed that only lateral BNP was significantly associated with urinary continence recovery 6 months or later after surgery. Although the lateral BNP technique did not affect immediate urinary continence recovery, this procedure was significantly associated with continence recovery 3 months or later after RARP.