Elsevier

Urology

Volume 55, Issue 6, June 2000, Pages 820-824
Urology

Rapid communications
Seminal vesicle-sparing radical prostatectomy: a novel concept to restore early urinary continence

https://doi.org/10.1016/S0090-4295(00)00547-1Get rights and content

Abstract

Objectives. Urinary incontinence after radical prostatectomy continues to be a distressing problem, even with preservation of the neurovascular bundles and meticulous apical dissection. Recent studies suggest that motor and sensory components of the pelvic nerve may be affected by surgery, since both components are anatomically located in intimate contact with the seminal vesicles. We propose seminal vesicle-sparing radical prostatectomy to preserve pelvic innervation and improve the rate of urinary continence.

Methods. Fifty-four patients were enrolled in this prospective study. A standard retropubic radical prostatectomy was performed in 34 patients. A seminal vesicle-sparing radical prostatectomy was performed in a pilot series of 20 consecutive patients. The seminal vesicle tip and surrounding tissue were preserved and carefully handled. In all patients, a modified pad test and posterior urethral sensory threshold test were performed preoperatively and 6 weeks and 6 months postoperatively and correlated with urinary continence.

Results. The intraoperative preservation of the seminal vesicle tip was possible in all patients in this pilot series (n = 20). In the seminal vesicle-sparing radical prostatectomy group, the continence rate was 60% after 6 weeks and 95% after 6 months. These rates were significantly higher than the continence rates in the standard prostatectomy group (18% and 82% at 6 weeks and 6 months, respectively). The sensory threshold levels in the seminal vesicle-sparing group were similar to the preoperative values and were significantly lower than the postoperative threshold levels in the standard prostatectomy group.

Conclusions. Seminal vesicle tip-sparing radical prostatectomy may be a surgical option to preserve pelvic innervation and maintain urinary continence after radical prostatectomy. Further randomized studies are necessary to elucidate the impact of seminal vesicle-sparing radical prostatectomy on restoration of urinary continence.

Section snippets

Material and methods

A total of 54 patients with clinically localized prostate cancer participated in this prospective consecutive study. Patients with stress incontinence before surgery were excluded. The characteristics of patients treated by standard retropubic radical prostatectomy (n = 34) and the seminal vesicle-sparing technique were similar (Table I). The seminal vesicle-sparing radical prostatectomy was performed in 20 consecutive patients.

After dissection of the urethra and lateral prostatic pedicles, the

Results

All enrolled patients were continent preoperatively. Intraoperative preservation of the seminal vesicle tip was possible in all 20 patients (Fig. 1). No abscess formation or local complications resulted from the remaining seminal vesicle stump. The seminal vesicle-sparing radical prostatectomy improved the rate of early urinary continence compared with the standard radical prostatectomy from 18% to 58% after 6 weeks (P = 0.004). After 6 months, the rate of urinary continence was significantly

Comment

The incidence of postoperative incontinence has improved considerably with a more accurate description of the neurovascular bundles and modifications in surgical technique, including meticulous apical dissection and preservation of the rhabdosphincter.4, 5 Nevertheless, urinary incontinence immediately after radical retropubic prostatectomy continues to be a distressing clinical problem. Several studies have shown that in the first 6 postoperative months, the quality of life of the patients is

Conclusions

The seminal vesicle tip-sparing radical prostatectomy to preserve pelvic innervation of the trigone and neobladder neck may be a future surgical technique to improve early urinary continence after radical prostatectomy. The use of this modification will need to be applied judiciously to cancers that are not likely to be invading the seminal vesicles.

Acknowledgements

To Stefan Schwyter for drawing Figure 1 and to Professor S. V. Yalla, M.D. and Maryrose P. Sullivan, Ph.D., Division of Urology, Veterans Affairs Medical Center, West Roxbury, Harvard Medical School, Boston, Massachusetts, for reviewing this paper.

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This study was supported by different grants from Zürich University Research Foundations (Zürcher Hochschulverein FAN, Hartmann-Müller, Stiefel-Zangger, Herzog-Egli, and Pottere-Leupold).

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