Document Detail


Impact of complete bladder neck preservation on urinary continence, quality of life and surgical margins after radical prostatectomy: a randomized, controlled, single blind trial.
MedLine Citation:
PMID:  23017512     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: We investigated the influence of bladder neck preservation on urinary continence, quality of life and surgical margins after radical prostatectomy.
MATERIALS AND METHODS: A total of 208 men who presented for radical prostatectomy were randomized to complete bladder neck preservation with subsequent urethro-urethral anastomosis or to no preservation as controls. Patients with failed bladder neck preservation were not included in study. We documented objective continence by the 24-hour pad test, social continence by the number of pads per day and quality of life outcomes by the validated Incontinence Quality of Life questionnaire in a single blind setting. Cancer resection was assessed by surgical margin status.
RESULTS: At 0, 3, 6 and 12 months mean urine loss in the control vs the bladder neck preservation group was 713.3 vs 237.0, 49.6 vs 15.6, 44.4 vs 5.5 and 25.4 vs 3.1 gm, respectively (each p <0.001). At 3, 6 and 12 months in the control vs the preservation group the social continence rate was 55.3% vs 84.2% (p <0.001), 74.8% vs 89.5% (p = 0.05) and 81.4% vs 94.7% (p = 0.027), and the quality of life score was 80.4 vs 90.3 (p <0.001), 85.4 vs 91.7 (p = 0.016) and 86.0 vs 93.8 (p = 0.001), respectively. We noted significantly less urine loss, higher objective and social continence rates, and higher quality of life scores after complete bladder neck preservation at all followup points. On multiple logistic regression analysis complete bladder neck preservation was an independent positive predictor of continence. No significant difference was found in surgical margin status between the control and bladder neck preservation groups (12.5% vs 14.7%, p = 0.65).
CONCLUSIONS: In what is to our knowledge the first prospective, randomized, controlled, single blind trial complete bladder neck preservation during radical prostatectomy was associated with a significantly higher urinary continence rate and increased patient satisfaction without compromising resection margins.
Authors:
Joanne N Nyarangi-Dix; Jan Philipp Radtke; Boris Hadaschik; Sascha Pahernik; Markus Hohenfellner
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2012-09-24
Journal Detail:
Title:  The Journal of urology     Volume:  189     ISSN:  1527-3792     ISO Abbreviation:  J. Urol.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-11     Completed Date:  2013-06-11     Revised Date:  2013-09-05    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  891-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Urology, University of Heidelberg, Heidelberg, Germany. jnyarangidix@yahoo.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Follow-Up Studies
Humans
Male
Middle Aged
Prospective Studies
Prostatectomy / adverse effects*
Prostatic Neoplasms / surgery*
Quality of Life*
Questionnaires
Single-Blind Method
Treatment Outcome
Urinary Bladder / surgery*
Urinary Incontinence / etiology,  physiopathology,  surgery*
Urination
Comments/Corrections
Comment In:
J Urol. 2013 Aug;190(2):815-6   [PMID:  23524200 ]
Eur Urol. 2013 Aug;64(2):338-9   [PMID:  23830226 ]

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