Freire, M. P. et al. Anatomic bladder neck preservation during robotic-assisted laparoscopic radical prostatectomy: description of technique and outcomes. Eur. Urol. doi:10.1016/j.eururo.2009.09.017

Credit: © Eraxion/Dreamstime

According to Jim C. Hu, senior author of a new paper published in European Urology, “bladder neck preservation [during robotic-assisted laparoscopic radical prostatectomy (RALP)] produces an earlier improvement in urinary function without any adverse effect on cancer control, as measured by the positive margin rate.”

Return of continence by 4 months was much more likely when the bladder neck had been spared...

During open radical prostatectomy, the precision of bladder neck dissection is enhanced by the surgeon's ability to palpate the prostate and urethral catheter balloon. The lack of this 'hands-on' information makes bladder neck dissection one of the most challenging skills to master during RALP training. In their paper, Hu and colleagues “describe anatomic landmarks and a consistently reproducible technique for performing bladder neck preservation [during RALP] that should reduce morbidity and improve outcomes.” Video footage of the procedure can be viewed via www.europeanurology.com.

The team prospectively compared outcomes between two groups. The first included 348 men who underwent RALP incorporating bladder neck preservation. The second group included 271 patients whose bladder neck was dissected using standard procedure during RALP.

Complication rates and blood loss were similar for both techniques. Bladder neck preservation resulted in better mean urinary function scores at 4 and 24 months. Return of continence by 4 months was much more likely when the bladder neck had been spared (66% of patients versus 27%). “In terms of outcomes, our observations reinforce some studies of open radical prostatectomy by showing that urinary function is better with bladder neck sparing versus non-sparing,” comments Hu.

Refinement of the technique to reduce the learning curve is underway. “We have described a nerve-sparing technique previously, and a technique for performing the anastomosis; we now hope to describe steps of the operation to improve understanding of the anatomy and to eventually standardize this procedure,” concludes Hu.