Bladder Neck Preservation Improves Continence After Prostatectomy

NEW YORK (Reuters Health) Oct 11 - Complete bladder neck preservation during radical prostatectomy improves the rate of urinary continence subsequently, a German team reports.
Furthermore, the strategy is associated with "increased patient satisfaction without compromising resection margins," the investigators reported online September 26 in the Journal of Urology.

Dr. Joanne N. Nyarangi-Dix and colleagues at the University of Heidelberg point out that functional outcomes and quality of life after radical prostatectomy are now widely considered to be just as important as cancer control.

Bladder neck preservation during radical prostatectomy is believed to improve urinary continence, but most studies on this subject have been nonrandomized and retrospective, the authors explain.
They therefore conducted a randomized study involving 208 men presenting for radical

prostatectomy at their institution. The study was single-blinded, i.e., the patients did not know if they had the complete bladder neck preservation (cBNP) procedure or not.

All the patients completed 12 months of follow-up. After excluding nine subjects, the analysis included 95 men who were assigned to cBNP and 104 non-BNP controls.

Surgical margin positivity rates were not significantly different between the two groups at 14.7% and 12.5% (p=0.13), the team found.

Mean urine loss, measured by 24-hour pad test, was significantly lower at three months postop in the cBNP group than the non-BNP group, at 15.6g vs 49.6g (p<0.001). This pattern continued during the follow-up year, and at 12 months respective urine loss rates were 3.1g vs 25.4g (p<0.001), the report indicates.

Rates of social continence - defined as use of no more than one pad per day - were 84.2% vs 55.3% (p<0.001) in the two groups, respectively, at three months; and 94.7% vs 81.4% (p=0.027) at 12 months.

These differences were reflected in quality-of-life scores. At three months, the QOL score was 90.3 in the cBNP group versus 80.4 in the non-BNP group (p<0.001). Corresponding figures at 12 months were 93.8 versus 86.0 (p=0.001), Dr. Nyarangi-Dix and colleagues report.

They conclude, "cBNP is associated with significantly higher early and overall continence rates and better QOL outcomes, without compromising cancer resection. Consequently, we recommend translation of these findings into routine practice: whenever possible cBNP is a goal to be strived for during radical prostatectomy."