Modified apical dissection for early continence after radical prostatectomy.

Abstract

A prospective evaluation of urinary continence in 83 consecutive patients undergoing radical prostatectomy using a modified apical urethral dissection is described. Using this technique, complete continence has been achieved in 88%, with stress incontinence in 11% and total incontinence in 1%. Continence was achieved in less than 1 week to a maximum of 16 weeks, with 17% dry during the first week, 53% dry by 6 weeks, and 81% by 3 months. Median time to continence was 5 weeks. Median age of the continent patients was significantly lower than that of incontinent patients. Neither the number of neurovascular bundles resected, the need to reconstruct the vesical neck, nor the number of anastomotic sutures used affected the rate of continence. The described technique, which incorporates the fascia posterior to the urethra into the vesicourethral anastomosis, results in earlier continence after radical prostatectomy, and thereby lessens the morbidity of this procedure.