Bladder Neck Contracture After Retropubic Radical Prostatectomy: Incidence And Risk Factors From A Large Single-surgeon Experience

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 16 Aug 2009 - 0:00 PDT

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UroToday.com - In the online edition of the British Journal of Urology International, Dr. Bradley Erickson reports on the incidence of bladder neck contractures in men undergoing open radical retropubic prostatectomy. The data includes 4,132 patients in a single surgeon series of Dr. William Catalona's patients.

The patients were operated on from 1983 to 2007 and had at least one year of follow-up. Men had a bilateral nerve sparing prostatectomy when deemed appropriate. The bladder neck is reconstructed in a racquet handle fashion using 2-0 chromic to a size of 22-24 French. The mucosa is everted using 3-0 chromic from the 9 to 3 o'clock position. Initially, 4 interrupted 2-0 chromic sutures were used and this was increased to 5 plus an additional suture when considered necessary. The sutures are placed at 2, 4, 6, 8, and 10 o'clock positions. Knots are tied under direct vision with the aid of a hand held retractor. The surgeons report the importance of a dry surgical bed and water-tight anastomosis. The catheter is taken out on day 10. Clinical and pathologic data was assessed with regard to the presence of a bladder neck contracture. A bladder neck contracture was considered confirmed if a 17 F cystoscope could not easily be navigated into the bladder.

Of the 4,132 men in the database, a total of 110 were identified to have a bladder neck contracture. Patients with a bladder neck contracture were older (65 vs. 61 years) with a higher clinical stage, a higher median PSA level (6.7 vs. 5.7), but similar levels of positive surgical margins (20-22%) and organ-confined cancer. A bladder neck contracture was more likely to occur in a patient who would have biochemical progression of their CaP and require eventual radiotherapy. Men experiencing a bladder neck contracture were more likely to have a lower potency rate (49% vs. 63%) and lower continence rate (88% vs. 94%).

Patients operated on early in the surgical series were more likely to have a bladder neck contracture and the initial rate of 17% decreased to <1% over time. The mean time to developing a bladder neck contracture was 100 days. Multivariate analysis revealed that time of surgery, median PSA level, year of surgery and non-nerve sparing surgical technique were significant predictors of bladder neck contracture.

Erickson BA, Meeks JJ, Roehl KA, Gonzalez CM, Catalona WJ
BJU Int. 2009 Jul 2. Epub ahead of print.
doi:10.1111/j.1464-410X.2009.08700.x

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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