1941 FULL FUNCTIONAL LENGTH URETHRAL SPHINCTER PRESERVATION DURING OPEN RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized IX1 Apr 20101941 FULL FUNCTIONAL LENGTH URETHRAL SPHINCTER PRESERVATION DURING OPEN RADICAL PROSTATECTOMY Thorsten Schlomm, Oliver Engel, Thomas Steuber, Hans Heinzer, Alexander Haese, Georg Salomon, Hartwig Huland, and Markus Graefen Thorsten SchlommThorsten Schlomm More articles by this author , Oliver EngelOliver Engel More articles by this author , Thomas SteuberThomas Steuber More articles by this author , Hans HeinzerHans Heinzer More articles by this author , Alexander HaeseAlexander Haese More articles by this author , Georg SalomonGeorg Salomon More articles by this author , Hartwig HulandHartwig Huland More articles by this author , and Markus GraefenMarkus Graefen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1930AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A key prerequisite for urinary continence after radical prostatectomy is the functional length of the urethral sphincter. As demonstrated by functional studies, the intraprostatic urethra between apex and colliculus is an important part of the urethral sphincter complex. Dependence on the apex shape, a significant part of the functional urethra is covered by parenchymal apex tissue. Our modified technique is aimed to preserve the muscular part of the intraprostatic urethra. METHODS We modified our surgical technique by an individualized apical preparation to preserve the full functional length urethra (FFLU). Overall 918 consecutive patients who underwent RRP between May 2008 and July 2009 were analyzed. All surgical procedures were performed by four high volume surgeons. There was no significant difference between the FFLU (n=310) and the non-FFLU (n=608) group with respect to patient age, ASA-status, BMI, preoperative PSA, pT stage, prostatectomy Gleason score, prostate volume, extent of nerve sparing, and preoperative continence. Continence rates were assessed at 7 days and 3 month after removal of the catheter. Multiple logistic regression was used to assess the efficacy of our technical modifications in respect to the continence rates one week after catheter removal. RESULTS The continence rate one week after catheter removal, defined as no pad at all or one protective pad was 79.9% and 72.9% in patients operated with the FFLU technique vs. non-FFLU technique (p=0.017, Pearson chi-square). After 3 month the percentage of continent patients rose to 96.6% and 96.4%, respectively. Early continence results were stratified by age, extent of nerve sparing (non-nervesparing vs. unilateral vs. bilateral approach), BMI, ASA-status, pT-stage, prostatectomy Gleason, preoperative PSA, prostate volume, and surgical technique (FFLU vs. non-FFLU). In multivariate regression analysis, only patient age (p=0.001), ASA-status (p=0.005) and surgical technique (p<0.0001) correlated significantly with the continence status one week after catheter removal. The overall positive surgical margin rates (pT2 and pT3) differed not significantly between the surgical techniques (13.6% vs. 14.9%). CONCLUSIONS The urinary continence results obtained with our modified surgical technique support or concept of an individualized full functional length urethral sphincter preparation. Hamburg, Germany© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e754 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thorsten Schlomm More articles by this author Oliver Engel More articles by this author Thomas Steuber More articles by this author Hans Heinzer More articles by this author Alexander Haese More articles by this author Georg Salomon More articles by this author Hartwig Huland More articles by this author Markus Graefen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...