title: The impact of bladder neck mucosal eversion during open radical prostatectomy on bladder neck stricture and urinary extravasation.
abstract: OBJECTIVE
  To determine whether the bladder neck mucosal eversion (BNM-eversion) during radical retropubic prostatectomy (RRP) reduces the risk of bladder neck stricture (BNS) and of peri-anastomotic extravasation (PAE) in postoperative cystography.
  
  
  METHODS
  Two hundred and eleven patients with clinically localized prostate cancer underwent RRP and were prospectively randomized into patients with BNM-eversion (group I) and without BNM-eversion (group II). All patients underwent an evaluation of PAE by retrograde cystography on postoperative day 8. We assessed BNS after 6 months.
  
  
  RESULTS
  Ninety-two patients with and 113 patients without BNM-eversion were included. There was no significant difference in baseline characteristics, including age, TNM-classification, Gleason score, PSA, prostate volume, and blood loss in both groups. A complete follow-up of 6 months for BNS was available for 188 patients (89.1 %). Sixteen BNS out of 188 patients were recorded, 4.7 % (n = 4) in group I and 11.7 % (n = 12) in group II (p = 0.09). Data from 205 out of 211 patients were available for the evaluation of the extravasation by cystography. Peri-anastomotic extravasation was detectable in 11.96 %, (11/205) in group I and in 21.24 % (24/205) in group II (p = 0.08).
  
  
  CONCLUSIONS
  BNM-eversion does not have a positive influence on the prevention of bladder neck strictures. Peri-anastomotic extravasation detected by cystography does not correlate with a formation of bladder neck stricture.
authors.affiliation: Department of Urology, University Hospitals Grosshadern, Ludwig-Maximilians-University, Munich, Germany. gita.schoeppler@med.uni-heidelberg.de
authors.forename: Gita M
authors.initials: GM
authors.lastname: Schoeppler
authors.forename: Dirk
authors.initials: D
authors.lastname: Zaak
authors.forename: Dirk-Andre
authors.initials: DA
authors.lastname: Clevert
authors.forename: Petra
authors.initials: P
authors.lastname: Schuhmann
authors.forename: Oliver
authors.initials: O
authors.lastname: Reich
authors.forename: Michael
authors.initials: M
authors.lastname: Seitz
authors.forename: Wael Y
authors.initials: WY
authors.lastname: Khoder
authors.forename: Michael
authors.initials: M
authors.lastname: Staehler
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.forename: Alexander
authors.initials: A
authors.lastname: Buchner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology*; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic / Q000209:etiology; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000209:etiology; D006454:Hemoglobins; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery*; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D011859:Radiography; D018709:Statistics, Nonparametric; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000601:surgery; D001745:Urinary Bladder Diseases / Q000209:etiology*
chemical_list: D006454:Hemoglobins; D017430:Prostate-Specific Antigen