Intussusception of the reconstructed bladder neck leads to earlier continence after radical prostatectomy

Introduction. Although there is no evidence that the reconstructed bladder neck actively contributes to post-radical prostatectomy continence, we set out to determine whether buttressing sutures, which prevent the bladder neck from pulling open as the bladder fills, would result in the earlier return of urinary control. Technical Considerations. Forty-five men (mean age 57 years, range 37 to 67) with clinical localized prostate cancer underwent anatomic radical retropubic prostatectomy with standard tennis racket bladder neck reconstruction. The bladder neck was then intussuscepted using two 2-0 Maxon Lembert sutures placed lateral and posterior to the reconstructed bladder neck. Filling of the bladder with saline at this point revealed little leakage. Patient-reported continence at 3 months was compared with the published outcome of 64 men using the same quality-of-life instrument (the UCLA Prostate Cancer Index). At 3 months, 82% of men who underwent intussusception of the bladder neck were continent (no pad/dry pad) compared with 54% in our prior report (P = 0.0035). The occurrence of bladder neck contracture was similar: 7% versus 5%. Conclusions. Intussusception of the bladder neck led to a significant improvement in urinary control at 3 months postoperatively. Longer follow-up will be necessary to determine whether this approach may eliminate the 2% probability of long-term significant problems with urinary control.