Radical prostatectomy with preservation of urinary continence: pathology and long-term results.

摘要

PURPOSE:: A continence sparing radical retropubic prostatectomy is described and evaluated. Results are compared with those of patients who underwent a standard anatomical radical retropubic prostatectomy previously by the same surgeon. MATERIALS AND METHODS:: A total of 275 consecutive patients underwent a continence sparing radical prostatectomy by a single surgeon (DLG) between 1996 and 2003. The technique is described in detail. RESULTS:: Total continence (no pad or device) was found immediately upon catheter removal in 36% of patients, within 14 days in 69% and within 7 weeks in 78%, compared to 1%, 6% and 41% of 80 patients who underwent the standard operation. Median time to total continence was 1 day for the new group versus 63 days for the standard surgery group. Positive margins were found in 6.9% of the new group versus 11% of the first 80 patients. Of the former patients 80% have a prostate specific antigen of less than 0.2 ng/ml at an average followup of 12.5 years. With the new procedure 90% of patients have a prostate specific antigen of less than 0.2 ng/ml with an average followup of 5.2 years. There was no operative mortality or unusual complication. The typical patient was discharged home 1 to 3 days postoperatively. CONCLUSIONS:: Preservation of the continence mechanism at the level of the bladder neck and proximal prostatic urethra results in earlier return of continence without adversely affecting cancer control. It is a relatively simple way to improve surgical results.