title: A new technique of bladder neck reconstruction during radical prostatectomy in patients with prostate cancer.
abstract: OBJECTIVE
  To evaluate continence after radical prostatectomy in prostate cancer patients, in whom a new method of the bladder neck reconstruction (BNR) using deep dorsal stitch was implemented (deep single stitch through all bladder layers directly dorsal to the bladder opening after ″ tennis racket″ reconstruction) and to provide justification for its use by means of anatomical study in cadavers.
  
  
  METHODS
  Open radical retropubic prostatectomy was performed in 84 patients: 39 patients with a new BNR method used to improve continence and control group of 45 patients with standard ″tennis racket″ BNR. Median follow-up was 14 months in control group and 12 months in study group. Continence recovery was accessed early postoperatively and every 3 months thereafter. Anatomical study was performed on 2 male fresh cadavers reproducing two different BNR techniques to clarify any underlying continence related mechanisms.
  
  
  RESULTS
  Patients with new BNR achieved full continence significantly faster (p=0.041), but the continence rates after 12 months were similar between groups. The severity of incontinence up to month 9 was significantly reduced in BNR group. The anastomotic stricture rate was not affected. Applying new BNR to the cadaver model revealed effects on early continence, namely presence of proximal passive closure mechanism in area of bladder neck.
  
  
  CONCLUSIONS
  Continence in patients with the new BNR method using deep dorsal stitch recovered significantly faster. Moreover, a reduced grade of residual incontinence was documented. The effect was non-significant at month 12 of follow-up, meaning that only early effect was present.
authors.affiliation: Hannover Medical School, Urology and Urologic Oncology Clinic, 30625 Hannover, Deutschland.|Military Medical Academy, Urology Clinic, 194044 Saint-Petersburg, Russia.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Tolkach
authors.affiliation: Südharz Klinikum Nordhausen, Urology Clinic, 99734 Nordhausen, Deutschland.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Godin
authors.affiliation: Military Medical Academy, Urology Clinic, 194044 Saint-Petersburg, Russia.
authors.forename: Sergey
authors.initials: S
authors.lastname: Petrov
authors.affiliation: Kalmar County Hospital, 39231 Kalmar, Sweden.
authors.forename: Sonny
authors.initials: S
authors.lastname: Schelin
authors.affiliation: Hannover Medical School, Urology and Urologic Oncology Clinic, 30625 Hannover, Deutschland.
authors.forename: Florian
authors.initials: F
authors.lastname: Imkamp
mesh_terms: D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery; D001743:Urinary Bladder / Q000601:surgery*; D014549:Urinary Incontinence / Q000601:surgery