Outcomes after radical retropubic prostatectomy

To determine whether urinary incontinence after radical retropubic prostatectomy (RRP) for prostate cancer is improved by the preservation of the puboprostatic ligaments or bladder neck; whether impotency is reduced by the preservation of the neurovascular bundles; and whether positive surgical margins are a risk with more precise bladder neck and apical dissection.

RRP was performed sequentially in three groups using tennis racquet reconstruction, bladder neck preservation, or bladder neck and puboprostatic ligament preservation, and continence and surgical margin status were assessed. Also, recovery of potency and surgical margin status were evaluated when both, one, or no neurovascular bundles were preserved.

A total of 244 patients had a social continence rate of 90%, 100%, and 89% after tennis racquet reconstruction, bladder neck preservation, or bladder neck and puboprostatic ligament preservation, respectively. The mean time to recovery of continence was similar for tennis racquet reconstruction (2.3 months) and bladder neck preservation (2.9 months) but was longer (P <0.05) for bladder neck and puboprostatic ligament preservation (4.3 months). Although 9% of cases had positive margins, no margins were positive only at the bladder neck. Of a total of 188 patients potent preoperatively, 72% underwent bilateral nerve-sparing surgery. All men younger than 50 years old, 87% of men aged 50 to 59 years, 70% of men aged 60 to 69 years, and 38% of men older than 70 years of age were potent. The surgical margins were positive in 9% of patients who underwent bilateral nerve-sparing surgery, and the site of margin positivity was the apex only in 3% of patients.

Neurovascular bundle and bladder neck preservation decrease morbidity and rarely risk margin positivity. Bladder neck plus puboprostatic ligament preservation delays and does not improve overall continence.