A Comparative Study of Bladder Neck Preservation Versus Bladder Neck Reconstruction during Retropubic Radical Prostatectomy in Term of Urinary incontinence
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Background: Urinary continence remains a critical functional outcome following radical prostatectomy. Bladder neck preservation has been advocated to improve postoperative continence. While BNR has been widely reported, evidence focusing on the impact of BNP, particularly on early continence following open retropubic radical prostatectomy (RRP), remains limited.
Objective: To evaluate early and late urinary continence outcomes following bladder neck preservation during open retropubic radical prostatectomy and to compare these results with bladder neck reconstruction outcomes reported in the literature.
Patients and Methods: This prospective study was conducted at Al-Sadr Teaching Hospital, Al-Najaf, between January 2022 and January 2025. Patients with clinically localized prostate cancer underwent open retropubic radical prostatectomy with intentional bladder neck preservation. Postoperative follow-up was performed at 3, 6, and 12 months. Primary outcomes included early and late urinary continence recovery. Secondary outcomes included vesicourethral anastomotic stenosis and surgical margin status.
Results: Bladder neck preservation was associated with favorable early continence recovery, with a notable proportion of patients achieving continence within the first postoperative months. Continence rates further improved over time, resulting in high late continence rates at 12 months, comparable to late continence outcomes reported in bladder neck reconstruction series. At the 3-month follow-up, urinary continence was achieved in 90% of patients. This proportion further increased to 95% at 6 months. By the 12-month follow-up, all patients (100%) had achieved full urinary continence. Vesicourethral anastomotic stenosis occurred in two patients and was successfully managed endoscopically. All patients demonstrated negative surgical margins.
Conclusion: Bladder neck preservation during open retropubic radical prostatectomy appears to confer its principal functional advantage in enhancing early urinary continence, while maintaining late continence outcomes comparable to bladder neck reconstruction techniques reported in the literature. This approach offers a meaningful early quality-of-life benefit without compromising oncological safety and represents a viable alternative to bladder neck reconstruction.
1. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17–48.
2. Wein AJ, Kavoussi LR, Partin AW, Peters CA, editors. Campbell-Walsh Urology. 12th ed. Philadelphia: Elsevier; 2021.
3. International Agency for Research on Cancer (IARC). GLOBOCAN 2020: Prostate cancer factsheet. Lyon: WHO; 2020.
4. Bawahab MA, Alkhateeb SS, Elfeel AA, et al. Prostate cancer in Saudi Arabia: epidemiological and clinical characteristics. Saudi Med J. 2020;41(5):487–492.
5. Humphrey PA, Moch H, Cubilla AL, et al. The 2016 WHO classification of tumours of the urinary system and male genital organs. Eur Urol. 2016;70(1):93–105.
6. Epstein JI, Egevad L, Amin MB, et al. The 2014 ISUP Gleason grading system. Am J Surg Pathol. 2016;40(2):244–252.
7. Fendler WP, Calais J, Eiber M, et al. Assessment of 68Ga-PSMA PET for lymph node staging. JAMA Oncol. 2019;5(6):875–883.
8. Calais J, Czernin J. The clinical landscape of PSMA PET imaging. J Nucl Med. 2022;63(1):59–65.
9. Hofman MS, Lawrentschuk N, Francis RJ, et al. ProPSMA: a prospective study of PSMA PET accuracy. Lancet. 2020;395(10231):1208–1216.
10. Mottet N, van den Bergh RCN, Briers E, et al. EAU Guidelines on Prostate Cancer 2023. Eur Urol. 2023;84(3):190–210.
11. D’Amico AV, Whittington R, Malkowicz SB, et al. Biochemical outcome after radical prostatectomy. JAMA. 1998;280(11):969–974.
12. Eastham JA, Kattan MW, Rogers E, et al. Risk factors for urinary incontinence after radical prostatectomy. J Urol. 1996;156(5):1707–1713.
13. Walsh PC. Anatomic radical prostatectomy: evolution of the surgical technique. J Urol. 1998;160(6 Pt 2):2418–2424.
14. Choi YH, Rha KH, Jeon SH. Functional outcomes of open versus robotic radical prostatectomy. Investig Clin Urol. 2019;60(1):14–20.
15. American Urological Association. Clinically localized prostate cancer: AUA guideline. 2022.
16. European Association of Urology. EAU Guidelines on Prostate Cancer. Arnhem: EAU Guidelines Office; 2022.
17. European Board of Urology. Urology training curriculum. EBU; 2023.
18. Koraitim MM. The male urethral sphincter complex revisited. J Urol. 2008;179:1683–1689.
19. Dorschner W, Stolzenburg JU, Neuhaus J. Structure and function of the bladder neck. Adv Anat Embryol Cell Biol. 2001;159:1–109.
20. Myers RP. Practical surgical anatomy for radical prostatectomy. Urol Clin North Am. 2001;28:473–490.
21. Cornu JN, Phé V, Fournier G, Delmas V, Sèbe P. Fascia surrounding the prostate. Surg Radiol Anat. 2010;32(7):663–667.
22. Roberts MJ, Papa N, Perera M, et al. Declining use of radical prostatectomy. Asia Pac J Clin Oncol. 2020;16(2):e118–e124.
