Full Functional-Length Urethral Sphincter Preservation During Radical Prostatectomy

• Published in: European urology Vol. 60; no. 2; pp. 320 - 329
• Main Authors: Schlomm, Thorsten, Heinzer, Hans, Steuber, Thomas, Salomon, Georg, Engel, Oliver, Michl, Uwe, Haese, Alexander, Graefen, Markus, Huland, Hartwig
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier B.V 01.08.2011; Elsevier
• Subjects: Adult; Aged; Anatomy; Biological and medical sciences; Chi-Square Distribution; Continence; Germany; Gynecology. Andrology. Obstetrics; Humans; Logistic Models; Male; Male genital diseases; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Pelvic floor; Pelvic Floor - physiopathology; Pelvic Floor - surgery; Prostate cancer; Prostatectomy - adverse effects; Prostatectomy - methods; Quality of life; Radical prostatectomy; Retrospective Studies; Risk Assessment; Risk Factors; Sphincter; Surgical technique; Surveys and Questionnaires; Time Factors; Treatment Outcome; Tumors; Tumors of the urinary system; Urethra; Urethra - physiopathology; Urethra - surgery; Urinary Incontinence - etiology; Urinary Incontinence - physiopathology; Urinary Incontinence - prevention & control; Urinary tract. Prostate gland; Urology; Germany; Continence; Pelvic floor; Radical prostatectomy; Urethra; Sphincter; Anatomy; Prostate cancer; Surgical technique; Quality of life; Nephrology; Urinary system disease; Prostate disease; Malignant tumor; Urology; Length; Surgery; Prostatectomy; Technique; Male genital diseases; Cancer; Conservative treatment
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2011.02.040

Abstract Background A key prerequisite for urinary continence after radical prostatectomy (RP) is the functional length of the urethral sphincter and the stabilisation of its anatomic position within the pelvic floor. Objective We describe our modified surgical technique for full functional-length urethra (FFLU) preservation during RP. Design, setting, and participants We analysed 691 consecutive patients who underwent RP over a 12-mo period (285 without and 406 with the FFLU technique). Surgical procedure The full functional urethra length was preserved by performing an individualised apical preparation strictly along anatomic landmarks, respecting the individual length of the intraprostatically located proportion of the urethral sphincter. Anatomic fixation of the sphincter was reached by a thorough preservation of the pelvic floor and anatomic restoration of the Mueller's ligaments. Measurements Continence rates were assessed at 7 d and 12 mo after removal of the catheter. Continence was defined as the use of no pads and no urinary leakage. Results and limitations The continence rates were 50.1% and 30.9% 1 wk after catheter removal ( p < 0.0001) and 96.9% and 94.7% ( p = 0.59) at 12 mo after surgery in patients operated on with the FFLU technique versus the non-FFLU technique. In multivariate regression analysis, only the surgical technique correlated significantly with the continence status 1 wk after catheter removal. Neither the overall positive surgical margin rates nor the number of positive margins at the urethral resection border differed significantly between the FFLU and non-FFLU groups (13.6% and 0.5% vs 14.9% and 1.3%, respectively). Although the patients’ baseline characteristics were similar in the two surgical groups, the patients were not preoperatively randomised, and the number of patients in the groups was asymmetric. Conclusions The combination of an FFLU preparation and improved preservation of the anatomic fixation of the urethral sphincter complex resulted in significantly increased early urinary continence results.