The Null Effect of Bladder Neck Size on Incontinence Outcomes After Radical Prostatectomy

Overview

Journal J Urol

Publisher Wolters Kluwer

Specialty Urology

Date 2017 Jun 29

PMID 28655528

Citations 3

Authors

Mark D Tyson 2nd

Jacob Ark

Justin R Gregg

Niels V Johnsen

Stephen F Kappa

Daniel J Lee

Joseph A Smith Jr

Affiliations

Soon will be listed here.

Abstract

Purpose: We sought to determine whether bladder neck size is associated with incontinence scores after robot-assisted laparoscopic radical prostatectomy.

Materials And Methods: Consecutive eligible patients undergoing robot-assisted laparoscopic radical prostatectomy between July 19 and December 28, 2016 were enrolled in a prospective, longitudinal, observational cohort study. The primary outcome was patient reported urinary incontinence on the EPIC (Expanded Prostate Cancer Index Composite) scale 6 and 12 weeks postoperatively. The relationship between the EPIC score of urinary incontinence and bladder neck size was evaluated by multiple regression. Predicted EPIC scores for incontinence were displayed graphically after using restricted cubic splines to model bladder neck size.

Results: A total of 107 patients were enrolled. The response rate was 98% and 87% at 6 and 12 weeks, respectively. Bladder neck size was not significantly associated with incontinence scores at 6 and 12 weeks. Comparing the 90th percentile for bladder neck size (18 mm) with the 10th percentile (7 mm) revealed no significant difference in adjusted EPIC scores for incontinence at 6 weeks (β coefficient 0.88, 95% CI -10.92-12.68, p = 0.88) or at 12 weeks (β coefficient 5.80, 95% CI -7.36-18.97, p = 0.39).

Conclusions: These findings question the merit of creating an extremely small bladder neck during robot-assisted laparoscopic radical prostatectomy. We contend that doing so increases the risk of positive margins at the bladder neck without facilitating early recovery of continence.

Citing Articles

Vesicoprostatic muscle reconstruction: a step further for immediate and early urinary continence.

Gao Y, Yang Y, Li X, Wang T, Cheng Q, Jia Z World J Urol. 2023; 41(6):1511-1517.

PMID: 37093318 DOI: 10.1007/s00345-023-04398-9.

Bladder neck size and its association with urinary continence after robot-assisted radical prostatectomy.

Kohjimoto Y, Higuchi M, Yamashita S, Kikkawa K, Hara I BJUI Compass. 2023; 4(2):181-186.

PMID: 36816148 PMC: 9931543. DOI: 10.1002/bco2.188.

Surgical techniques to improve continence recovery after robot-assisted radical prostatectomy.

Urkmez A, Ranasinghe W, Davis J Transl Androl Urol. 2021; 9(6):3036-3048.

PMID: 33457277 PMC: 7807332. DOI: 10.21037/tau.2020.03.36.

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