Bladder-neck preservation during radical retropubic prostatectomy

The goal of the urologic surgeon performing total prostatectomy for prostate cancer is to eliminate the cancer and minimize the side effects associated with treatment. We believe that careful dissection of the prostate from the bladder can be performed in such a manner as to preserve most of the circular fibers of the bladder neck. This so-called bladder-neck preservation technique appears to reduce the risk of an anastomotic stricture and accelerate the return of urinary continence. An analysis of 676 consecutive prostatectomies revealed that 4.3% of the men had tumor touching the inked bladder neck margin. Only 1% had this as the only positive margin. Most of these patients had a preoperative prostate-specific antigen > 10 and a Gleason score of 7 or greater suggesting that bladder-neck preservation did not compromise the outcome of surgery. A more extensive resection of the bladder neck is not likely to be curative.