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Complete bladder neck preservation promotes long-term post-prostatectomy continence without compromising midterm oncological outcome: analysis of a randomised controlled cohort

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Abstract

Purpose

The only RCT available on complete bladder neck preservation (cBNP) during radical prostatectomy reported superior continence and QoL outcomes in the first 12 months after cBNP. We provide the first data on long-term urinary continence, QoL and biochemical recurrence (BCR) after complete bladder neck preservation in a randomised controlled cohort.

Methods

After approval by IRB, 199 men recruited for the randomised, controlled single-blind Heidelberger cBNP Study had prostatectomy performed with (cBNP) or without (noBNP) complete bladder neck preservation. Only men with renewed consent for this follow-up were evaluated for continence, QoL outcomes and BCR by ICIQ-SF self-assessment questionnaire, Pad-use/day and PSA levels. Students-t test, Pearson´s Chi-square, Fishers exact test and multiple logistic regression analyses were applied.

Results

Mean follow-up was approx. 4 years. There were no significant differences in baseline characteristics between responders/non-responders or between study groups. We noted significantly higher continence rates (p = 0.004), less pad-use (p < 0.001), reduced frequency (p = 0.023) and amount (p = 0.009) of urine loss, and higher QoL outcomes (p = 0.012) after cBNP. A younger age positively influenced continence (OR = 0.91), but the multivariate analysis found cBNP to be the only independent predictor of continence (p = 0.008; OR = 8.1). pT stage was the only predictor for positive surgical margins (PSM; p < 0.001). There was no significant difference in pT stage (p = 0.23) or BCR (p = 0.63) between study groups and also no significant correlation between BCR and presence (p = 0.26) or localisation (p = 0.11) of PSM, nerve sparing (p = 0.70), surgeon (p = 0.41), preoperative PSA (p = 0.53) or pT stage (p = 0.17). No cancer-related death was noted.

Conclusions

Results of this first follow-up on a prospective randomised controlled cohort demonstrate that cBNP is associated with significantly higher continence and QoL outcomes without compromising cancer control making cBNP a novel objective during radical prostatectomy.

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Abbreviations

BNP:

Bladder neck preservation

CaP:

Prostate cancer

cBNP:

Complete bladder neck preservation

cBNP-RP:

Complete bladder neck preserving radical prostatectomy

ICIQ-SF:

International Consultation on Incontinence Questionnaire-Short Form

QoL:

Quality of life

RP:

Radical prostatectomy

PSM:

Positive surgical margin

FU:

Follow up

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Author information

Authors and Affiliations

  1. Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Joanne N. Nyarangi-Dix, Gencay Hatiboglu, Georgi Tosev & Markus Hohenfellner

  2. Department of Biostatistics, German Cancer Research Center, Heidelberg, Germany

    Diana Tichy

  3. Department of Urology, Klinikum Nürnberg, Nuernberg, Germany

    Sascha Pahernik

Authors
  1. Joanne N. Nyarangi-Dix
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  2. Diana Tichy
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  3. Gencay Hatiboglu
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  4. Sascha Pahernik
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  5. Georgi Tosev
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  6. Markus Hohenfellner
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Contributions

JNN-D: project development, Data collection, Data analysis, Manuscript writing; DT: Data analysis (Multiple logistic regression analysis); GT: Data collection; GH: Data analysis, Manuscript editing; SP: Manuscript editing; MH: project development, Critical revision, Manuscript editing.

Corresponding author

Correspondence to Joanne N. Nyarangi-Dix.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in the study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments.

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Nyarangi-Dix, J.N., Tichy, D., Hatiboglu, G. et al. Complete bladder neck preservation promotes long-term post-prostatectomy continence without compromising midterm oncological outcome: analysis of a randomised controlled cohort. World J Urol 36, 349–355 (2018). https://doi.org/10.1007/s00345-017-2134-1

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  • DOI: https://doi.org/10.1007/s00345-017-2134-1

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