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Nerve-sparing Surgery Technique, Not the Preservation of the Neurovascular Bundles, Leads to Improved Long-term Continence Rates After Radical Prostatectomy

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Michl U., Tennstedt P., Feldmeier L., Mandel P., Oh S.J., Ahyai S., Budäus L., Chun F.K.H., Haese A., Heinzer H., Salomon G., Schlomm T., Steuber T., Huland H., Graefen M., Tilki D.

European Urology 2015

Background: The effect of preservation of neurovascular bundles (NVBs) during radical prostatectomy (RP) on continence remains controversial. Objective: To analyze if the differing surgical techniques of nerve-sparing (NS) versus non-nerve-sparing (NNS) RP and not the preservation of the NVB itself may be responsible for differences in continence rates. Design, setting, and participants: A total of 18 427 men who underwent RP from 2002 to 2014 in a single high-volume center were analyzed retrospectively. Patients with bilateral NS RP, with primary NNS RP, and with bilateral secondary resection of the NVBs for positive frozen-section results after an initial bilateral nerve sparing (secNNS) RP were studied. Intervention: NS, NNS, or secNNS RP. Outcome measurements and statistical analysis: Multivariable and propensity score matched analyses adjusting for age, prostate volume, and year of surgery were performed to assess differences in continence rates after RP. Continence was defined as the use of no or one safety pad per day. Results and limitations: Post-RP urinary continence rates at 1 wk, 3 mo, and 12 mo were 59.8%, 76.2%, 85.4% in the NS group, 39.5%, 59.5%, and 87.0% in the secNNS group, and 29.1%, 52.8%, and 70.5% in the NNS group. Continence rates at 12 mo after surgery did not differ significantly between patients who had bilateral NS and patients who had resection of both NVBs after an initial nerve-sparing technique (secNNS). In contrast, when comparing the NNS study groups with initial NNS versus secNNS, the latter group had significantly higher continence rates after 12 mo. Conclusions: Our results indicate that the meticulous apical dissection associated with the NS RP technique rather than the preservation of the NVBs itself may have a positive impact on long-term urinary continence rates. Patient summary: We looked at continence rates after nerve-sparing (NS) versus non-NS radical prostatectomy (RP). NS surgery technique but not the preservation of the neurovascular bundles led to improved long-term continence rates after RP. Meticulous apical dissection associated with the nerve-sparing radical prostatectomy (RP) technique rather than the preservation of neurovascular bundles itself may have a positive impact on long-term urinary continence rates after RP.

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