Improved continence with tubularized bladder neck reconstruction following radical retropubic prostatectomy.
OBJECTIVE
Incontinence after radical retropubic prostatectomy remains a common problem. This study determines the efficacy of a tubularized bladder neck reconstruction for improving the time to continence and also the total rate of continence following radical retropubic prostatectomy.


METHODS
Tubularized bladder neck reconstruction was performed in 29 patients by creating a trapezoidal-shaped anterior bladder flap and performing tubularization over a 30 F red rubber catheter prior to urethrovesical anastomosis. This flap measured approximately 5 cm at its base and 3 cm at its apex. Continence rates of these patients were compared to results of 30 randomly selected patients in whom a bladder flap was not used.


RESULTS
Seven of 29 (24%) patients with tubularized bladder neck reconstruction were fully continent within 24 hours of catheter removal and 27 of 29 (93%) were fully continent by 3 months follow-up. An additional patient was continent at 6 months for a total continence rate of 28 of 29 (97%). These continence rates were significantly higher at all follow-up times than for patients in whom an anterior bladder flap was not used. One patient developed a bladder neck contracture and was successfully managed with visual urethrotomy. He is fully continent.


CONCLUSIONS
Tubularized bladder neck reconstruction following radical prostatectomy may both increase the successful achievement of postoperative continence and decrease the time needed to achieve full continence without increasing morbidity.
Seaman
E K
EK
J. Bentley Squier Urologic Clinic, Columbia-Presbyterian Medical Center, Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
Benson
M C
MC
D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011184:Postoperative Period; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000517:prevention & control; D014554:Urination