BERKELEY, CA (UroToday.com) - The main goal of radical prostatectomy for localized prostate cancer is to achieve the trifecta of urinary continence, erectile function, and cancer control. This paper focused on technical aspects to reduce positive surgical margins (PSMs) of robot-assisted radical prostatectomy (RARP). A PSM following radical prostatectomy is a significant risk factor for recurrence and correlates with decreased cancer-specific and overall survival. Many surgeons feel that the most difficult step of RARP is the dissection of the bladder neck because there are a lot of variations in size, deviation, and tumor volume for the bladder neck. This paper compares PSM of pT2 disease in two techniques of bladder neck dissection, which are conventional midline dissection and the modified ultradissection. In the modified ultradissection, the lateral border of the bladder neck was dissected and then the bladder neck was transected. The rate of PSM on the bladder neck was significantly reduced, from 6.2 % to 0 (p<0.05), by the modified ultradissection. There was no change in the rate of PSM in the other areas.
This was a retrospective study, but the patient background and the risk profiles of PSM were similar in the two groups. The better visualization of bladder neck by the modified ultradissection has the potential to reduce PSM. The prospective randomized trial should be awaited.
Written by:
Motoo Araki, MD, PhD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Associate Professor; Department of Urology; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; 2-5-1 Shikata-cho Okayama-shi; Okayama 700-8558 Japan
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