title: Continence outcomes after bladder neck preservation during robot-assisted laparoscopic prostatectomy (RALP).
abstract: OBJECTIVE
  Urinary incontinence is one of the major prostate cancer treatment-related morbidities. We review our initial robot-assisted laparoscopic prostatectomy (RALP) experience, focusing on post-surgery continence rates.
  
  
  METHODS
  Two-hundred and thirty-three consecutive patients were identified from a prospectively maintained RALP database. A bladder neck sparing dissection was preferentially performed during transperitoneal RALP. On postoperative day 5 or 6 (clinic logistics), the urethral catheter was removed following a normal cystogram.
  
  
  RESULTS
  Median operative time was 190 minutes and estimated blood loss was 75 mL. Three (1.3%) patients required bladder neck reconstruction, while 198 (85.0%) had bilateral, 20 (8.6%) had unilateral and 15 (6.4%) did not undergo nerve sparing prostatectomy. One-hundred and ninety-nine (85.4%) patients had negative surgical margins. Median hospitalization and urethral catheter duration were 1.0 and 5.0 days, respectively. At six weeks, a median 1.0 pad per day usage was reported and mean AUASS and QoL were significantly improved from baseline (p < 0.05). Of the 220 patients having a minimum three-month follow-up, 152 (69.1%) achieved urinary continence without pads. Age, AUASS, QoL, prostate volume and prior TUR surgery independently had significant impact on early continence rate (p < 0.05).
  
  
  CONCLUSIONS
  A bladder neck sparing dissection allows for early return of urinary continence following RALP without compromising cancer control.
authors: a 1 Department of Urology, University of Oklahoma Health Sciences Center , Oklahoma City, OK, USA.|b 2 Department of Urology, Clinical Medical College at Yangzhou University , Yangzhou, Jiangsu, China.
authors: Xiao
authors: X
authors: Gu
authors: c 3 Department of Urology, Okayama University Graduate School of Medicine , Shikata-cho Okayama-shi, Okayama, Japan.
authors: Motoo
authors: M
authors: Araki
authors: d 4 SouthWest Urology, LLC , Middleburg Heights, OH, USA.
authors: Carson
authors: C
authors: Wong
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D059351:Organ Sparing Treatments / Q000379:methods; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012371:Robotics; D001743:Urinary Bladder / Q000601:surgery; D014549:Urinary Incontinence / Q000209:etiology / Q000517:prevention & control*
keywords: Laparoscopy; bladder neck; radical prostatectomy; robot; urethrovesical anastomosis; urinary continence