Radical prostatectomy with preservation of urinary continence: pathology and long-term results

A continence sparing radical retropubic prostatectomy is described and evaluated. Results are compared with those of patients who underwent a standard anatomical radical retropubic prostatectomy previously by the same surgeon.

A total of 275 consecutive patients underwent a continence sparing radical prostatectomy by a single surgeon (DLG) between 1996 and 2003. The technique is described in detail.

Total continence (no pad or device) was found immediately upon catheter removal in 36% of patients, within 14 days in 69% and within 7 weeks in 78%, compared to 1%, 6% and 41% of 80 patients who underwent the standard operation. Median time to total continence was 1 day for the new group versus 63 days for the standard surgery group. Positive margins were found in 6.9% of the new group versus 11% of the first 80 patients. Of the former patients 80% have a prostate specific antigen of less than 0.2 ng/ml at an average followup of 12.5 years. With the new procedure 90% of patients have a prostate specific antigen of less than 0.2 ng/ml with an average followup of 5.2 years. There was no operative mortality or unusual complication. The typical patient was discharged home 1 to 3 days postoperatively.

Preservation of the continence mechanism at the level of the bladder neck and proximal prostatic urethra results in earlier return of continence without adversely affecting cancer control. It is a relatively simple way to improve surgical results.