[Reconstruction of the bladder neck after radical retropubic prostatectomy using a tubular bladder flap]

To improve urinary continence after retropubic prostatectomy, especially in the early postoperative phase, we used a 1.5 cm tubularized anterior bladder flap for bladder neck reconstruction in 30 patients. We compared the continence rates of these patients with 30 patients with standard bladder neck closure operated on in the same period of time. Continence rates were assessed by a personal interview 1 day after catheter removal (postoperative day 22) and 3 months postoperatively by a questionnaire. While only 2/30 (6.6%) of the patients with standard bladder neck closure were completely continent 1 day after catheter removal, 9/30 (30%) of the patients with the tubularized neourethra were completely dry. After 3 months the standard procedure led to a 58% rate of complete continence. This was achieved in 75% of patients with the tubularized flap. Ten percent of the patients with conventional operations developed a bladder neck contracture. This complication occurred in 20% of the patients with the new method. Analyzing subgroups, we found that patients with a tubularized neourethra who received adjuvant irradiation of the prostatic bed because of positive surgical margins developed a bladder neck stenosis in 40% of the cases due to shrinking of the flap.