MP83-05 THE EFFECT OF NERVE-SPARING ON URINARY CONTINENCE AFTER RADICAL PROSTATECTOMY: IS IT THE PRESERVATION OF THE NEUROVASCULAR BUNDLES OR THE SURGICAL TECHNIQUE WHICH LEADS TO IMPROVED CONTINENCE RATES?

You have accessJournal of UrologyProstate Cancer: Localized IX1 Apr 2015MP83-05 THE EFFECT OF NERVE-SPARING ON URINARY CONTINENCE AFTER RADICAL PROSTATECTOMY: IS IT THE PRESERVATION OF THE NEUROVASCULAR BUNDLES OR THE SURGICAL TECHNIQUE WHICH LEADS TO IMPROVED CONTINENCE RATES? Derya Tilki, Sascha Ahyai, Pierre Tennstedt, Markus Graefen, Hartwig Huland, and Uwe Michl Derya TilkiDerya Tilki More articles by this author , Sascha AhyaiSascha Ahyai More articles by this author , Pierre TennstedtPierre Tennstedt More articles by this author , Markus GraefenMarkus Graefen More articles by this author , Hartwig HulandHartwig Huland More articles by this author , and Uwe MichlUwe Michl More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1880AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The effect of the preservation of the neurovascular bundles (NVB) during radical prostatectomy (RP) on continence remains controversial. We hypothesized that the differing surgery techniques of nerve-sparing versus non nerve-sparing RP and not the preservation of the NVB itself may be responsible for differences in continence rates. METHODS A total of 16734 who underwent RP from 2002 to 2014 in a single high-volume center were retrospectively analyzed. The following three patient groups were studied: Patients with bilateral nerve-sparing (NS) RP, patients with primary non nerve-sparing (NNS) RP and patients with bilateral secondary resection of the NVBs for positive frozen section results after an initial bilateral nerve-sparing (secNNS) RP. Propensity score-matched analysis adjusting for age, prostate volume and year of surgery was performed to assess differences in continence rates 1 week, 3 months and 12 months after RP between the different study groups. Continence was defined as the use of 0 or 1 safety pad per day. RESULTS Urinary continence rates at 1 week / 3 months / 12 months after surgery were 50.0%/77.4%/88.7%, 32.1%/52.8%/75.5% and 39.6%/61.3%/86.8% in the NS, NNS and secNNS groups, respectively. In the propensity score matched analysis, urinary continence rates at 12 months post-surgery did not significantly differ 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 non nerve-sparing study groups with initial NNS versus secondary NNS (secNNS), the secNNS group had significantly higher continence rates even after 12 months. CONCLUSIONS Our results indicate that the meticulous apical dissection associated with the nerve-sparing RP technique rather than the preservation of the NVBs itself may have a positive impact on long-term urinary continence rates. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1051 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Derya Tilki More articles by this author Sascha Ahyai More articles by this author Pierre Tennstedt More articles by this author Markus Graefen More articles by this author Hartwig Huland More articles by this author Uwe Michl More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...