Laparoscopic radical prostatectomy with bladder neck preservation: positive surgical margin and urinary continence status

Abstract

Introduction: Preservation of the bladder neck (BN) has been controversial, as limited excision of the bladder neck may result in incomplete resection of the disease. Moreover, the urinary continence rate may not be improved.

Aim: To evaluate the effect of bladder neck sparing on urinary continence, and surgical margins status in prostate cancer (PCa) patients treated with laparoscopic radical extraperitoneal prostatectomy.

Material and methods: A retrospective analysis of 295 consecutive patients who had undergone laparoscopic radical extraperitoneal prostatectomy for clinically localised prostate cancer in a single institution was performed. Positive surgical margin (SM(+)) and urinary continence status at 3, 6, and 12 months were evaluated.

Results: The distribution of SM(+) for pT2, pT3, and pT4a was 15.3% (27/176), 49.1% (58/118), and 100% (1/1), respectively. Overall, there were 55.61%, 80.61%, and 84.69% of men continent at 3, 6, and 12 months, respectively. However, when limiting the analysis to those who did not receive adjuvant radiotherapy within 12 months following surgery, urinary continence rates were 59.23%, 85.86%, and 90.21% at 3, 6, and 12 months, respectively. Preoperative prostate-specific antigen (PSA) and pathological T stage were identified as significant predictors of positive surgical margins.

Conclusions: Laparoscopic radical extraperitoneal prostatectomy with bladder neck preservation has been a safe procedure which has resulted in good functional outcome. We observed a relatively high incidence of positive surgical margins which could be attributed to a large number of extracapsular disease cases.

Keywords: bladder neck preservation; laparoscopic radical prostatectomy; surgical margin; urinary continence.

Figure 1

Kaplan-Meier curve showing the biochemical recurrence-free survival rates (progression PSA greater than 0.2 ng/ml) according to surgical margin status BCR-free survival – biochemical recurrence-free survival; SM(+) – positive surgical margin, SM(–) – negative surgical margin, PSA – prostate-specific antigen

Figure 2

Kaplan-Meier curve showing biochemical recurrence-free survival rates (progression PSA greater than 0.2 ng/ml) according to preoperative PSA strata in men with negative surgical margin BCR-free survival – biochemical recurrence-free survival, PSA – prostate-specific antigen

Figure 3

Kaplan-Meier curve showing biochemical recurrence-free survival rates (progression PSA greater than 0.2 ng/ml) according to preoperative PSA strata in men with positive surgical margin BCR-free survival – biochemical recurrence-free survival, PSA – prostate- specific antigen