Nerve sparing open radical retropubic prostatectomy--does it have an impact on urinary continence?
OBJECTIVE
We prospectively assessed the role of nerve sparing surgery on urinary continence after open radical retropubic prostatectomy.


METHODS
We evaluated a consecutive series of 536 patients who underwent open radical retropubic prostatectomy with attempted bilateral, unilateral or no nerve sparing, as defined by the surgeon, without prior radiotherapy at a minimum followup of 1 year with documented assessment of urinary continence status. Because outlet obstruction may influence continence rates, its incidence and management was also evaluated.


RESULTS
One year after surgery 505 of 536 patients (94.2%) were continent, 27 (5%) had grade I stress incontinence and 4 (0.8%) had grade II stress incontinence. Incontinence was found in 1 of 75 (1.3%), 11 of 322 (3.4%) and 19 of 139 patients (13.7%) with attempted bilateral, attempted unilateral and without attempted nerve sparing, respectively. The proportional differences were highly significant, favoring a nerve sparing technique (p <0.0001). On multiple logistic regression analysis attempted nerve sparing was the only statistically significant factor influencing urinary continence after open radical retropubic prostatectomy (OR 4.77, 95% CI 2.18 to 10.44, p = 0.0001). Outlet obstruction at the anastomotic site in 33 of the 536 men (6.2%) developed at a median of 8 weeks (IQR 4 to 12) and was managed by dilation or an endoscopic procedure.


CONCLUSIONS
The incidence of incontinence after open radical retropubic prostatectomy is low and continence is highly associated with a nerve sparing technique. Therefore, nerve sparing should be attempted in all patients if the principles of oncological surgery are not compromised.
Burkhard
Fiona C
FC
Department of Urology, University of Bern, 3010 Bern, Switzerland.
Kessler
Thomas M
TM
Fleischmann
Achim
A
Thalmann
George N
GN
Schumacher
Martin
M
Studer
Urs E
UE
D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D012307:Risk Factors; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology; D014549:Urinary Incontinence / Q000209:etiology* / Q000628:therapy; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000628:therapy