Is “extreme” bladder neck preservation in robot-assisted radical prostatectomy a safe procedure?

Introduction: The aim was to investigate the surgical and pathological outcomes of an “extreme” bladder neck preservation in prostate cancer patients treated with robotic radical prostatectomy. The greatest concern about the “extreme” bladder neck preservation is the potential risk of creating a positive surgical margin at the level of bladder neck. Materials and methods: We prospectively collected data from 88 patients with diagnosed prostate cancer who underwent robotic radical prostatectomy with “‘extreme’ bladder neck preservation.” All surgical procedures were performed by the same expert surgeon (F.D.M.). In this study, “‘extreme’ bladder neck preservation” was considered when the length of the spared intraprostatic segment of bladder neck was ⩾1 cm. We compared the histopathologic data with those of a homogeneous similar cohort of 88 consecutive patients who underwent robotic radical prostatectomy without bladder neck preservation. Results: The two groups analyzed were comparable according to clinical and pathological characteristics. A positive surgical margin at the level of bladder neck was found in five (5.7%) cases in the “extreme” bladder neck preservation group and in six cases (6.8%) in the no–bladder neck preservation group. The prostatic base was involved by neoplasia in 14 and 19 patients (15.9% and 21.6%, respectively); of these, five (35.7%) and six (31.6%) had positive surgical margin at the level of bladder neck, respectively. The pathological staging in positive surgical margin at the level of bladder neck patients was pT3 in five (100%) cases in the “extreme” bladder neck preservation group and in four (66.7%) cases when we decided not to preserve the bladder neck. Conclusion: We demonstrated that “extreme” bladder neck preservation is a safe oncological procedure with similar pathologic findings of a comparable no–bladder neck preservation series. Positive surgical margins at the level of bladder neck are linked to neoplasia with adverse pathological features, rather than the “extreme” bladder neck preservation procedure.

Effect of Bladder Neck Preservation on Long-Term Urinary Continence after Robot-Assisted Laparoscopic Prostatectomy: A Systematic Review and Meta-Analysis

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.