title: Role of bladder neck preservation in urinary continence following radical retropubic prostatectomy.
abstract: OBJECTIVE
  To report our experience of the influence of bladder neck preservation on patient continence.
  
  
  METHODS
  Radical retropubic prostatectomy with bladder neck preservation was performed in 131 patients (age range 48-73 years; mean 64.5 years). Urinary continence was evaluated using a validated questionnaire at follow-up visits and telephone interviews. All patients reporting incontinence were studied using a pad test and urodynamics.
  
  
  RESULTS
  After a mean follow-up period of 21.7 months (range 4-47 months), 115 patients were continent (87%) and 16 incontinent. According to the International Continence Society criteria, three had severe, three moderate and 10 mild incontinence. Urodynamics revealed sphincter deficiency in 15 cases, which was associated with decreased bladder compliance in four, while decreased compliance was the only abnormality in one. Continence was recovered 0-27 months after surgery (mean 3.2 months): 40% of men were continent within the first month and 74% within the third. Histopathology revealed positive margins in 30/131 patients (22%), but exclusively at the bladder neck level in only seven (5%), and two also had positive nodes. Six patients (4.5%) presented bladder neck stenosis requiring transurethral incision. No statistically significant differences were found between the ages of continent and incontinent men or between the time to continence recovery with two different techniques of retropubic hemostasis; however, use of a nerve-sparing technique significantly reduced the time to continence recovery.
  
  
  CONCLUSIONS
  Bladder neck preservation during radical retropubic prostatectomy does not improve the long-term results of urinary continence but does contribute substantially to its earlier recovery, thus improving the quality of life. With proper patient selection the risk of positive margins at the bladder neck level only is reasonably low.
authors.affiliation: Department of Urology, University of Pisa, Pisa, Italy. c.selli@med.unipi.it
authors.forename: Cesare
authors.initials: C
authors.lastname: Selli
authors.forename: Pietro
authors.initials: P
authors.lastname: De Antoni
authors.forename: Umberto
authors.initials: U
authors.lastname: Moro
authors.forename: Angelo
authors.initials: A
authors.lastname: Macchiarella
authors.forename: Gianluca
authors.initials: G
authors.lastname: Giannarini
authors.forename: Alfonso
authors.initials: A
authors.lastname: Crisci
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis; D011336:Probability; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011788:Quality of Life; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D001743:Urinary Bladder / Q000601:surgery*; D014549:Urinary Incontinence / Q000453:epidemiology / Q000517:prevention & control*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000379:methods