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Vol. 38. Issue 7.
Pages 421-428 (September 2014)
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Vol. 38. Issue 7.
Pages 421-428 (September 2014)
Original article
Preservation of the internal vesical sphincter and proximal urethra during retropubic radical prostatectomy may improve earlier recovery of continence in selected patients
La preservación del esfínter interno vesical y la uretra proximal durante la prostatectomía radical retropúbica puede mejorar la recuperación temprana de la continencia en pacientes seleccionados
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E. Brunocilla, R. Schiavina, M. Borghesi
Corresponding author
mark.borghesi@gmail.com

Corresponding author.
, C. Pultrone, V. Vagnoni, M.S. Rossi, M. Cevenini, L. Bianchi, E. Molinaroli, G. Gentile, G. Martorana
Departamento de Urología, Universidad de Bolonia, Hospital S. Orsola-Malpighi, Bolonia, Italy
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Tables (3)
Table 1. Clinical and pathological characteristics of the two groups.
Table 2. Continence rate (defined as continence vs. incontinence) at 3, 7, 30 days and at 3 and 12 months in the two groups (G. 1 and G. 2) in the whole population of 110 patients.
Table 3. Multivariate logistic regression analysis for the predictive factor of urinary continence at 3 and 7 days after catheter removal.
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Abstract
Objectives

To evaluate the influence of preservation of the muscular internal sphincter and proximal urethra on continence recovery after radical prostatectomy (RP).

Materials and methods

Fifty-five consecutive patients with organ confined prostate cancer were submitted to RP with the preservation of muscular internal sphincter and the proximal urethra (group 1) and compared to 55 patients submitted to standard procedure (group 2). Continence rates were assessed using a self-administrated questionnaire at 3, 7, 30 days and 3, 12 months after removal of the catheter.

Results

Group 1 had a faster recovery of continence than group 2 at 3 days (50.9% vs. 25.5%; p=.005), at 7 days (78.2% vs. 58.2%; p=.020), at 30 days (80.0% vs. 61.8%; p=.029) and at 3 months (81.8% vs. 61.8%; p=.017); there were no statistical difference in terms of continence at 12 months among the two groups. Multivariate logistic regression analysis of continence showed that surgical technique was significantly associated with earlier time to continence at 3 and 7 days. The two groups had no significant differences in terms of surgical margins.

Conclusions

Our modified technique of RP with preservation of smooth muscular internal sphincter as well as of the proximal urethra during bladder neck dissection resulted in significantly increased early urinary continence at 3, 7, 30 days and 3 months after catheter removal. The technique does not increase the rate of positive margins and the duration of the procedure.

Keywords:
Radical prostatectomy
Urinary sphincter
Urethra
Urinary continence
Prostate cancer
Resumen
Objetivos

Evaluar la influencia de la preservación del esfínter interno muscular y la uretra proximal en la recuperación de la continencia después de la prostatectomía radical (PR).

Material y métodos

Cincuenta y cinco pacientes consecutivos con cáncer de próstata confinado al órgano se sometieron a PR con preservación del esfínter interno muscular y la uretra proximal (grupo 1), y se compararon con 55 pacientes sometidos a un procedimiento estándar (grupo 2). Las tasas de continencia se evaluaron mediante un cuestionario autoadministrado a los 3, 7 y 30 días y 3 y 12 meses después de la retirada del catéter.

Resultados

El grupo 1 tuvo una recuperación más rápida de la continencia que el grupo 2 a los 3 días (50,9 vs. 25,5%; p=0,005), a los 7 días (78,2 vs. 58,2%; p=0,020), a los 30 días (80,0 vs. 61,8%; p=0,029) y a los 3 meses (81,8 vs. 61,8%; p=0,017); no hubo diferencia estadísticamente en términos de continencia a los 12 meses entre los 2 grupos. El análisis de regresión logística multivariante de la continencia mostró que la técnica quirúrgica se asoció significativamente con un tiempo temprano hasta la continencia a los 3 y 7 días. Ninguno de los 2 grupos presentó diferencias significativas en cuanto a márgenes quirúrgicos.

Conclusiones

Nuestra técnica modificada de PR con preservación del esfínter interno muscular liso, así como de la uretra proximal durante la disección del cuello de la vejiga, dio como resultado un aumento de la continencia urinaria temprana a los 3, 7 y 30 días y 3 meses después de la retirada del catéter. La técnica no aumenta la tasa de márgenes positivos ni la duración del procedimiento.

Palabras clave:
Prostatectomía radical
Esfínter urinario
Uretra
Continencia urinaria
Cáncer de próstata

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