Bladder neck preservation following radical prostatectomy: continence and margins

Between December 1991 and January 1994, 134 patients underwent radical retropubic prostatectomy with bladder neck preservation. Forty-nine patients had a positive margin. Number and location of positive margins were analyzed. A tumor was identified at the bladder neck in 10 cases (7.5%). In all 10 patients with bladder neck involvement, a tumor was also identified at multiple other sites. These data suggest that preservation of the bladder neck during radical prostatectomy does not appear to compromise the efficacy of the procedure. Using a self-administered patient questionnaire, we evaluated the effect of bladder neck preservation upon continence in 36 patients. At the initial 3-month follow-up, 24 (67%) patients did not wear any pads. Another 7 (19%) wore pads occasionally, while 5 (14%) patients wore pads daily. To date only 1 of the 134 patients has developed an anastomotic stricture. Bladder neck preservation may aid in an earlier return of continence following radical prostatectomy and reduces anastomotic strictures. It does not appear to compromise the removal of the cancer.