Rapid communicationsSeminal vesicle-sparing radical prostatectomy: a novel concept to restore early 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).