Simple suturing of the bladder neck muscle layer at the vesicourethral anastomosis site to the dorsal vein complex during anterior reconstruction led to a better postoperative urinary continence after robot-assisted laparoscopic prostatectomy

This study aimed to evaluate the effect of bladder neck preservation (BNP) on long-term urinary continence after robot-assisted laparoscopic prostatectomy (RALP). We systematically searched the PubMed, Embase, and Cochrane Library databases to identify studies that assessed the difference in urinary continence and oncologic outcomes between patients who underwent RALP with BNP and those who underwent RALP without BNP. Four trials (1880 cases with BNP, 727 controls without BNP) were considered suitable for meta-analysis. BNP was associated with significantly better urinary continence outcomes at 3–4 months (odds ratio (OR), 2.88; 95% confidence interval (CI), 1.52–5.48; p = 0.001), 12 months (OR, 2.03; 95% CI, 1.10–3.74; p = 0.02), and 24 months (OR, 3.23; 95% CI, 1.13–9.20; p = 0.03) after RALP. There was no difference in the rate of overall positive surgical margin (PSM) (OR, 1.00; 95% CI, 0.72–1.39; p = 0.99) and that of PSM at the prostate base (OR, 0.49; 95% CI, 0.21–1.13; p = 0.09) between the two groups. The BNP technique during RALP leads to early return of urinary continence and long-term urinary continence without compromising the oncologic outcomes.

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The Impact of Lateral Bladder Neck Preservation on Urinary Continence Recovery After Robot-Assisted Radical Prostatectomy

Journal of Endourology ◽

10.1089/end.2017.0459 ◽

2018 ◽

Vol 32 (1) ◽

pp. 40-45 ◽

Cited By ~ 6

Author(s):

Takeshi Hashimoto ◽

Kunihiko Yoshioka ◽

Tatsuo Gondo ◽

Kazuki Hasama ◽

Yosuke Hirasawa ◽

...

Keyword(s):

Radical Prostatectomy ◽

Bladder Neck ◽

Urinary Continence ◽

Robot Assisted ◽

Neck Preservation ◽

The Impact

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Impact of bladder neck angle measured by postoperative magnetic resonance imaging on mid-term recovery of urinary continence in prostate cancer patients undergoing robot-assisted radical prostatectomy

Journal of Endourology ◽

10.1089/end.2021.0071 ◽

2021 ◽

Author(s):

Toshiki Ito ◽

Kyohei Watanabe ◽

Yuto Matsushita ◽

Hiromitsu Watanabe ◽

Keita Tamura ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Prostate Cancer ◽

Magnetic Resonance ◽

Radical Prostatectomy ◽

Cancer Patients ◽

Bladder Neck ◽

Urinary Continence ◽

Resonance Imaging ◽

Robot Assisted ◽

Postoperative Magnetic Resonance Imaging

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Intraoperative measurements of urethral length and bladder neck diameter as predictors of urinary continence after robot-assisted radical prostatectomy

European Urology Open Science ◽

10.1016/s2666-1683(20)33779-4 ◽

2020 ◽

Vol 19 ◽

pp. e1758

Author(s):

Y. Kohjimoto ◽

M. Higuchi ◽

Y. Ueda ◽

T. Iguchi ◽

H. Koike ◽

...

Keyword(s):

Radical Prostatectomy ◽

Bladder Neck ◽

Urinary Continence ◽

Robot Assisted ◽

Neck Diameter

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Effect of Bladder Neck Preservation and Posterior Urethral Reconstruction during Robot-Assisted Laparoscopic Radical Prostatectomy for Urinary Continence

Korean Journal of Urology ◽

10.4111/kju.2012.53.1.29 ◽

2012 ◽

Vol 53 (1) ◽

pp. 29 ◽

Cited By ~ 27

Author(s):

Youn Chul You ◽

Tae Hyo Kim ◽

Gyung Tak Sung

Keyword(s):

Radical Prostatectomy ◽

Bladder Neck ◽

Laparoscopic Radical Prostatectomy ◽

Urinary Continence ◽

Urethral Reconstruction ◽

Robot Assisted ◽

Neck Preservation

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NeuroSAFE robot-assisted laparoscopic prostatectomy versus standard robot-assisted laparoscopic prostatectomy for men with localised prostate cancer (NeuroSAFE PROOF): protocol for a randomised controlled feasibility study

BMJ Open ◽

10.1136/bmjopen-2018-028132 ◽

2019 ◽

Vol 9 (6) ◽

pp. e028132 ◽

Cited By ~ 7

Author(s):

Eoin Dinneen ◽

Aiman Haider ◽

Clare Allen ◽

Alex Freeman ◽

Tim Briggs ◽

...

Keyword(s):

Prostate Cancer ◽

Feasibility Study ◽

Functional Outcomes ◽

Surgical Margin ◽

Urinary Continence ◽

Positive Surgical Margin ◽

Robot Assisted ◽

Laparoscopic Prostatectomy ◽

Patient Reported ◽

Randomised Controlled

IntroductionRobot-assisted laparoscopic prostatectomy (RALP) offers potential cure for localised prostate cancer but is associated with considerable toxicity. Potency and urinary continence are improved when the neurovascular bundles (NVBs) are spared during a nerve spare (NS) RALP. There is reluctance, however, to perform NS RALP when there are concerns that the cancer extends beyond the capsule of the prostate into the NVB, as NS RALP in this instance increases the risk of a positive surgical margin (PSM). The NeuroSAFE technique involves intraoperative fresh-frozen section analysis of the posterolateral aspect of the prostate margin to assess whether cancer extends beyond the capsule. There is evidence from large observational studies that functional outcomes can be improved and PSM rates reduced when the NeuroSAFE technique is used during RALP. To date, however, there has been no randomised controlled trial (RCT) to substantiate this finding. The NeuroSAFE PROOF feasibility study is designed to assess whether it is feasible to randomise men to NeuroSAFE RALP versus a control arm of ‘standard of practice’ RALP.MethodsNeuroSAFE PROOF feasibility study will be a multicentre, single-blinded RCT with patients randomised 1:1 to either NeuroSAFE RALP (intervention) or standard RALP (control). Treatment allocation will occur after trial entry and consent. The primary outcome will be assessed as the successful accrual of 50 men at three sites over 15 months. Secondary outcomes will be used to aid subsequent power calculations for the definitive full-scale RCT and will include rates of NS; PSM; biochemical recurrence; adjuvant treatments; and patient-reported functional outcomes on potency, continence and quality of life.Ethics and disseminationNeuroSAFE PROOF has ethical approval (Regional Ethics Committee reference 17/LO/1978). NeuroSAFE PROOF is supported by National Institute for Healthcare Research Research for Patient Benefit funding (NIHR reference PB-PG-1216-20013). Findings will be made available through peer-reviewed publications.Trial registration numberNCT03317990.

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