PURPOSE: To investigate the influence of bladder-neck-preservation (BNP) on urinary continence, QOL and surgical margins (SM) after radical prostatectomy (RP)
MATERIAL AND METHODS: 208 men presenting for RP were randomised for cBNP or control. Men after complete-BNP and subsequent urethro-urethral anastomosis were classified in cBNP-group and those without cBNP in noBNP-group. Patients with failed BNP were not included in the study. We documented objective continence by 24-hr-Pad-test, social continence by pads/day and QOL-outcomes by validated I-QOL-questionnaire in a single-blind setting. Cancer resection was assessed by SM-status.
RESULTS: Mean urine loss in noBNP vs. cBNP-group at 0, 3, 6 and 12 months was 713.3 vs. 237.0g (p< 0.001), 49.6 vs. 15.6g (p< 0.001), 44.4 vs. 5.5g (p< 0.001) and 25.4 vs. 3.1g (p< 0.001) respectively. Social continence rates at 3, 6 and 12 months were 55.3 vs. 84.2% (p< 0.001), 74.8 vs. 89.5% (p=0.05) and 81.4 vs. 94.7% (p=0.027); QOL-score was 80.4 vs. 90.3 (p< 0.001), 85.4 vs. 91.7 (p=0.016) and 86.0 vs. 93.8 (p=0.001) in noBNP- vs. cBNP-group respectively. We report significantly less urine loss, higher objective and social continence rates and higher QOL-scores after cBNP at all follow-up-time-points. In the multiple logistic regression analysis, we demonstrate that cBNP is an independent positive predictor of continence. No significant difference in SM-status between noBNP- vs. cBNP-group (12.5 vs. 14.7 % respectively, p=0.65) was found.
CONCLUSION: With this first prospective randomised controlled single-blind trial, we demonstrate that cBNP during RP is associated with significantly higher urinary continence rates as well as increased patient satisfaction without compromising resection margins.
Written by:
Nyarangi-Dix JN, Radtke JP, Hadaschik B, Pahernik S, Hohenfellner M. Are you the author?
Department of Urology, University of Heidelberg, Heidelberg, Germany.
Reference: J Urol. 2012 Sep 24. pii: S0022-5347(12)04972-5.
doi: 10.1016/j.juro.2012.09.082
PubMed Abstract
PMID: 23017512
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