title: A novel surgical technique for preserving the bladder neck during robot-assisted laparoscopic radical prostatectomy: preliminary results.
abstract: OBJECTIVE
  To describe our new surgical technique for preserving the bladder neck during robot-assisted laparoscopic prostatectomy (RALP) and to present the anatomy between the bladder neck and prostate.
  
  
  METHODS
  Between December 2012 and May 2014, 52 RALPs were performed at our institute. Demographic, perioperative, and postoperative data were recorded. Quality of life (QoL) scores were assessed before RALP, after urethral catheter removal, and at the first month after RALP. Fatty connective tissue between bladder neck and prostate was introduced, and circular muscle fibers of the internal sphincter were seen in all patients. Complications were classified according to the Clavien-Dindo classification. Statistical analyses were performed.
  
  
  RESULTS
  Mean follow-up was 9.6±5.2 months; mean age was 61.1±6.5 years. Our novel surgical technique for preserving the bladder neck was performed in 52 patients, and they were continent after catheter removal; mean duration of the catheter was 9.4±1.4 days. There was a significant difference in QoL before RALP and after catheter removal, however, but there was no statistical difference between before and 1 month after RALP (respectively; P<0.001, P=0.5). Furthermore, there was no complication related to the bladder neck such as bladder neck stricture, acute/chronic urinary retention, as well as no Clavien III, IV, and V complications. In addition, conventional laparoscopy and/or open surgery was not needed in any of the RALP cases.
  
  
  CONCLUSIONS
  Our novel technique provided very early continence at the time of catheter removal after RALP within short-term follow-up. This can help early recovery and develop QoL scores after RALP.
authors.affiliation: 1 Department of Urology, Gazi University School of Medicine , Ankara, Turkey .
authors.forename: Lutfi
authors.initials: L
authors.lastname: Tunc
authors.forename: Huseyin
authors.initials: H
authors.lastname: Gumustas
authors.forename: Yigit
authors.initials: Y
authors.lastname: Akin
authors.forename: Sinan
authors.initials: S
authors.lastname: Atkin
authors.forename: Tuncay
authors.initials: T
authors.lastname: Peker
authors.forename: Ozlem
authors.initials: O
authors.lastname: Erdem
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Bozkirli
mesh_terms: D000368:Aged; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery; D011788:Quality of Life; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods; D014421:Turkey; D001743:Urinary Bladder / Q000601:surgery*