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Improved continence with tubularized bladder neck reconstruction following radical retropubic prostatectomy
1J. Bentley Squier Urologic Clinic, Columbia-Presbyterian Medical Center, Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
Objectives:
Incontinence after radical retropubic prostatectomy remains a common problem. This study determines the efficacy of a tubularized bladder neck reconstruction for improving the time to continence and also the total rate of continence following radical retropubic prostatectomy.
Methods:
Tubularized bladder neck reconstruction was performed in 29 patients by creating a trapezoidal-shaped anterior bladder flap and performing tubularization over a 30 F red rubber catheter prior to urethrovesical anastomosis. This flap measured approximately 5 cm at its base and 3 cm at its apex. Continence rates of these patients were compared to results of 30 randomly selected patients in whom a bladder flap was not used.
Results:
Seven of 29 (24%) patients with tubularized bladder neck reconstruction were fully continent within 24 hours of catheter removal and 27 of 29 (93%) were fully continent by 3 months follow-up. An additional patient was continent at 6 months for a total continence rate of 28 of 29 (97%). These continence rates were significantly higher at all follow-up times than for patients in whom an anterior bladder flap was not used. One patient developed a bladder neck contracture and was successfully managed with visual urethrotomy. He is fully continent.
Conclusions:
Tubularized bladder neck reconstruction following radical prostatectomy may both increase the successful achievement of postoperative continence and decrease the time needed to achieve full continence without increasing morbidity.