BLADDER NECK PRESERVATION DURING ROBOTIC PROSTATECTOMY: IF THE ONLY CONCERN IS ABOUT POSITIVE SURGICAL MARGINS, THERE IS NO PROBLEM!

You have accessJournal of UrologyProstate & Renal Oncology II1 Apr 2018V08-02 BLADDER NECK PRESERVATION DURING ROBOTIC PROSTATECTOMY: IF THE ONLY CONCERN IS ABOUT POSITIVE SURGICAL MARGINS, THERE IS NO PROBLEM! Fabrizio Dal Moro, Michele Zazzara, Marina Paola Gardiman, Massimo Rugge, and Filiberto Zattoni Fabrizio Dal MoroFabrizio Dal Moro More articles by this author , Michele ZazzaraMichele Zazzara More articles by this author , Marina Paola GardimanMarina Paola Gardiman More articles by this author , Massimo RuggeMassimo Rugge More articles by this author , and Filiberto ZattoniFiliberto Zattoni More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1968AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The post-prostatectomy recovery of continence is influenced by multiple factors, both pre- and intra/post-operative. The bladder neck preservation (BNP), more accurate during robot assisted radical prostatectomy (RARP), works on two anatomic components responsible for post-prostatectomy continence (internal and external sphincter). Moreover, BNP spares the zone of urothelial coaptation and provides primary resistance to the urine to maintain urinary continence. The risk of having a positive surgical margins (PSM) at the level of spared bladder neck may limit the indications of BNP during RARP. The purpose of this study is to evaluate the surgical and pathological outcome in prostate cancer patients underwent RARP with BNP. METHODS We prospectively collected demographic, clinical, surgical and pathological data of patients underwent RARP with BNP, from January 2014 to December 2016. Moreover, our dedicated uro-pathologist performed a microscopic and macroscopic pathological analysis to evaluate the presence of alterations or continuous solutions of the capsule, specifically due to the surgical technique of BNP. BNP technique consisted of a complete dissection and preservation of the bladder neck and proximal urethra. We avoid any traction on the catheter balloon in order to better identify the bladder neck. With an athermal dissection of the plane between prostate and bladder we can minimize the traumatic effects on the longitudinal fibres of the bladder neck. RESULTS In order to have homogeneous data, from the total of 132 patients, we selected only the cases (88) performed by the same surgeon (FDM). Pathological stage was pT2a in 11 cases (12.5%), pT2b in 37 (42.1%), pT3a in 28 (31.8%) and pT3b in 12 patients (13.6%), with a lymph node involvement in 5 cases (5.7%). The definitive Gleason score was 6 in 10 cases (10.4%), 7 (3+4) in 30 (34.1%), 7 (4+3) in 20 (22.7%), 8 in 19 (21.,6%) and 9 in 9 patients (10.2%). In 5 patients (5.7%) there was a positive surgical margin at the level of bladder neck, but in all these cases there was also an involvement of the prostatic base (globally present in 14 cases). Pathological stage of the patients with bladder neck PSM was pT3a in 2 cases (40%) and pT3b in 3 (60%); in 3 cases (60%) there was a nodal involvement. Gleason score was 8 in 3 cases (60%) and 9 in 2 patients (40%). Nobody had alterations or continuous solutions of specimen external capsule, attributable to surgical technique BNP. CONCLUSIONS BNP during RARP is a safe oncological procedure. The bladder neck PSM are linked to neoplasia with adverse pathological features, rather than the BNP technique. BNP allows a more precise and accurate ″urethro-urethral″ anastomosis, avoiding any traction between urethral and bladder neck muscular layers and maintaining the urethral coaptation. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e819-e820 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Fabrizio Dal Moro More articles by this author Michele Zazzara More articles by this author Marina Paola Gardiman More articles by this author Massimo Rugge More articles by this author Filiberto Zattoni More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...