Retropubic Radical Prostatectomy and Immediate Continence

Abstract

Aim

Temporary urinary incontinence after removing the catheter in patients who have undergone radical prostatectomy is commonly accepted and considered inevitable. Detailed information can be found in literature regarding continence at 3, 6 and 12 months after operation, but few reports mention the immediate results upon removing the catheter. We have collected together data from our patients regarding continence upon removal of the catheter, in order to assess this important aspect.

Materials and methods

Between November ‘94 and August ‘98, 156 patients underwent retropubic radical prostatectomy for histologically diagnosed prostatic adenocarcinoma (average age 65 years, range 49–74). Out of 156 patients, the bladder neck was removed in 72 (46%) (RCV), in 43 (28%) the bladder neck circular fibres (CCV) were preserved and in 41 (26%) a new technique was used to anatomically dissect the bladder-prostate junction, preserving the mucous of the prostatic urethra (CUP). Continence immediately after removal of the catheter was assessed in all patients in orthostatism and under stress by filling the bladder with 150 cc of saline solution.

Results

Upon removal of the catheter, 59/130 patients (45.5%) were perfectly continent. Of these 26/72 (36%) had undergone ample removal of the bladder neck, the bladder neck circular fibres were spared in 18/43 (43%), whilst the proximal tract of the prostatic urethra had been preserved in 26/41 (63%). There was infiltration of the bladder neck in 11/156 patients (7%), none of whom had the bladder neck circular fibres or the end section of the prostatic urethra spared.

Conclusions

Our experience shows that in correctly selected patients, if the bladder neck circular fibres and the proximal tract of the prostatic urethra are preserved, the possibility of immediate continence is high without increasing the oncological risk.