Bladder neck preservation and its impact on positive surgical margins during radical prostatectomy

To modify the bladder neck dissection during radical prostatectomy, in an effort to improve continence and diminish the incidence of anastomotic stricture, without compromising the primary surgical objective of complete cancer removal. Between December 1991 and August 1992, 50 patients underwent radical retropubic prostatectomy with anatomic dissection and preservation of the bladder neck and most proximal portion of the prostatic urethra, thus creating a mucosal cuff for anastomosis to the urethral stump. There was tumor at the inked margin in 18 patients (36%), however, in only 3 instances (6%) was there tumor at the bladder neck margin. In no instance was the bladder neck margin the only positive margin. At a minimum follow-up of six months, all patients are fully continent during routine activities, and in no patient has an anastomotic stricture developed. Anatomic dissection and preservation of the bladder neck and proximal urethra does not compromise surgical margins. We believe this technique may play a role in preservation of continence after radical prostatectomy and probably decreases the likelihood of anastomotic stricture, by allowing for a circumferential mucosa-to-mucosa anastomosis without the need for bladder neck reconstruction.