UroToday - In the online edition of the British Journal of Urology International, Dr. David Webb and associates from Melbourne, Australia report the bladder neck contracture rates in men undergoing open radical prostatectomy (ORP) and robot-assisted radical prostatectomy (RALP).

A single-surgeon series of 200 consecutive men undergoing RP at two medical centers in Melbourne between March 2003 and September 2007 were analyzed. The 100 ORP patients had a conventional approach with bladder neck mucosa eversion and longitudinal racquet handle repair posteriorly. The urethra and bladder were anastomosed over a 20 F silicone catheter using four interrupted full thickness 2-0 absorbable sutures. In addition, a posterior suture at the 6 o'clock position held the bladder to the urethra in apposition. The catheter was removed at 5-6 days after RP. RALP was performed in 100 men with a nerve-sparing technique and none had bladder neck racquet handle reconstruction. The urethra-vesical anastomosis was made using continuous 3-0 absorbable sutures. Between 12 and 14 passages of the suture were made. The Foley catheter was removed 6-7 days after surgery. Worsening urinary stream or urinary retention resulted in endoscopic visualization to diagnose bladder neck contracture (BNC). Any BNC was endoscopically incised at the 6 o'clock position. Patients were then either discharged with a catheter, or on self-intermittent catheterization for 4-6 weeks. No patient had worsening continence due to BNC incision.

The rate of BNC was 0% in the RALP group compared to 9% in the ORP group. In addition, the ORP group had a higher prostate weight (54 vs. 46.5 gms) and preoperative PSA (7.3ng/ml vs. 5.0ng/ml). None of the 7 men with a prior history of TURP experienced a BNC. The time to BNC was 5 months and most occurred within 8 weeks.

Webb DR, Sethi K, Gee K
BJU Int. 2008 Dec 5. Epub ahead of print.

UroToday Contributing Editor Christopher P. Evans, MD, FACS

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