Urethra-sparing prostatectomy: indications, surgical technique, functional and oncologic results

Objective. To evaluate the effect of preserving proximal and distal segments of the prostatic urethra on functional and oncological outcomes retropubic prostatectomy.

Patients and methods. 97 men who underwent radical prostatectomy were divided into two groups. The first group (n = 49) included patients with complete retention of the bladder neck and prostatic urethra segments followed urethro- urethral anastomosis. The control group (n = 48) included patients who have not been saved the bladder neck. Continence control produced by the method of monitoring the daily amount of urine in the pad.
Social aspects and quality of life was assessed using conventional questionnaire. Radical surgery was evaluated by «negative surgical margin».

Results. Within 1, 3, 6 and 12 months after surgery the average loss of urine control patients with respect to patients of the study group was 741.3 g vs. 218.3 g, 56.9 g and 16.5 g, 48.7 g, against 8.5 g and 35.6 g from 3.3 g, respectively (for each comparison, p < 0.05). The indicator of the quality of life of the patients of the first group on all end points was significantly higher than those of the second group. There were no significant differences between
the frequency of «positive margins» in patients in the control group and the group with a fully preserved bladder neck (5.8 % vs. 5.4 %, p = 0.65).

Conclusions. Preservation of the bladder neck and proximal and distal segments of the prostatic urethra during radical prostatectomy significantly improved urinary function, and can achieve full satisfaction of quality of life in these patients compared with patients in the control group, subject to the necessary oncologic outcomes.

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