The role of bladder neck preservation during radical prostatectomy: clinical and urodynamic study

Bladder neck preservation has caused an increase in urinary continence following radical prostatectomy, and has given rise to much controversy. We have reviewed our clinical and urodynamic experience collected since 1995 in patients subjected to radical prostatectomy with bladder neck preservation.

180 patients were followed postoperatively using a pad test, an incontinence questionnaire and PSA dosage. In 66 early continent patients, test of maximum urethral closing pressure, functional length and active urethral continence were carried out, together with Valsalva leak point pressure tests and a pressure/flow study. The obtained data were then analysed.

Urinary continence was achieved in 132/180 men (73%) already two weeks after operation. Three months, six months and one year later the continence rate was 89%, 95.5% and 97.7% (176/180) respectively. As far as the urodynamic parameters of the 66 patients fully tested are concerned, all showed high results. The active urethral continence capacity exceeded 200 cm/water, and the Valsalva leak point pressure equalled or exceeded 150 cm/water.

Following an accurate dissection of the distal urethra, bladder neck preservation guarantees early recovery of continence, as confirmed by local urodynamic figures, and restores functional integration of both the urethral sphincteric-smooth proximal and distal striated units.