Felix Preisser1, Luis Busto Martin2, Raisa S Pompe2, Alexander Heinze2, Alexander Haese2, Markus Graefen2, Derya Tilki3. 1. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Frankfurt, Frankfurt, Germany. 2. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 3. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Electronic address: d.tilki@uke.de.
Abstract
OBJECTIVES: Previous studies reported improved continence recovery by bladder neck sparing (BNS) in prostate cancer patients treated with robot-assisted laparoscopic radical prostatectomy (RALP), without compromising biochemical recurrence (BCR). We compared the continence outcomes, surgical margin rates, and BCR risk of BNS vs. bladder neck reconstruction (BNR) patients during RALP. METHODS: Overall, 1,512 patients who underwent RALP with BNS or BNR between 2010 and 2017 in a single high-volume center, were identified. Logistic regression models tested the effect of BNS on continence and surgical margin rates. Cox regression models tested the effect of BNS on BCR. Continence was defined as the use of 0 or 1-safety pad per day. RESULTS: Three hundred and eighty-two vs. 1,130 patients underwent BNS vs. BNR. The median time to catheter removal was significantly shorter (5 vs. 8 days) in patients with BNS. Pad-free rates at 7 days after catheter removal were 60.0% vs. 54.5%, continence rates were 80.1% vs. 78.3% after 3 months and 85.3% vs. 89.6% after 1 year for BNS and BNR, respectively. Multivariable models revealed that BNS is an independent predictor to be pad-free at 7 days after catheter removal (OR: 1.39, P = 0.04), but no predictor for continence at 3 months (OR: 1.02, P = 0.9) and 1 year (OR: 0.78, P = 0.4) after RALP, as well as for positive surgical margin (OR: 0.95, P = 0.8) and BCR (Hazard ratio: 0.95, P = 0.9). CONCLUSION: Patients with BNS had a better chance to be pad-free at 7 days after catheter removal and had a significant shorter time to catheter removal. However, this beneficial effect disappeared with time and no differences in continence rates at 3 months and 1 year were recorded. Moreover, BNS did not negatively affect positive margin or BCR rates.
OBJECTIVES: Previous studies reported improved continence recovery by bladder neck sparing (BNS) in prostate cancerpatients treated with robot-assisted laparoscopic radical prostatectomy (RALP), without compromising biochemical recurrence (BCR). We compared the continence outcomes, surgical margin rates, and BCR risk of BNS vs. bladder neck reconstruction (BNR) patients during RALP. METHODS: Overall, 1,512 patients who underwent RALP with BNS or BNR between 2010 and 2017 in a single high-volume center, were identified. Logistic regression models tested the effect of BNS on continence and surgical margin rates. Cox regression models tested the effect of BNS on BCR. Continence was defined as the use of 0 or 1-safety pad per day. RESULTS: Three hundred and eighty-two vs. 1,130 patients underwent BNS vs. BNR. The median time to catheter removal was significantly shorter (5 vs. 8 days) in patients with BNS. Pad-free rates at 7 days after catheter removal were 60.0% vs. 54.5%, continence rates were 80.1% vs. 78.3% after 3 months and 85.3% vs. 89.6% after 1 year for BNS and BNR, respectively. Multivariable models revealed that BNS is an independent predictor to be pad-free at 7 days after catheter removal (OR: 1.39, P = 0.04), but no predictor for continence at 3 months (OR: 1.02, P = 0.9) and 1 year (OR: 0.78, P = 0.4) after RALP, as well as for positive surgical margin (OR: 0.95, P = 0.8) and BCR (Hazard ratio: 0.95, P = 0.9). CONCLUSION:Patients with BNS had a better chance to be pad-free at 7 days after catheter removal and had a significant shorter time to catheter removal. However, this beneficial effect disappeared with time and no differences in continence rates at 3 months and 1 year were recorded. Moreover, BNS did not negatively affect positive margin or BCR rates.
Authors: Che Hseuh Yang; Yi Sheng Lin; Yen Chuan Ou; Wei Chun Weng; Li Hua Huang; Chin Heng Lu; Chao Yu Hsu; Min Che Tung Journal: World J Clin Cases Date: 2021-02-16 Impact factor: 1.337