Urinary continence in patients undergoing nerve sparing radical prostatectomy

Recently, the morbidity of radical prostatectomy has been reduced by improvements in surgical techniques and greater understanding of pelvic anatomy. The nerve sparing technique has been considered to be a major contribution to this advance. In our study, urinary control was compared in 33 consecutive patients undergoing a radical retropubic prostatectomy. In 13 patients, a conventional radical prostatectomy was performed and in 20 subsequent patients, a nerve sparing operation was performed. The staff surgeons were the same throughout the study. The age of the patients and pathological stage of the tumor were not significantly different between the groups. The operative time was shorter and intraoperative blood loss was less both significantly in the nerve sparing group. In the conventional operated group, there was one patient with total incontinence and two with significant incontinence requiring absorbable pads. In the nerve sparing group, there were no patients having total incontinence and one had stress incontinence requiring absorbable pads. Urethral pressure profile was measured postoperatively in 17 in the nerve sparing group and in 7 in the conventional group. The maximum urethral pressure in the nerve sparing group was 31.5 cm H2O (SD = 5.4) and in the conventional group 23.2 cm H2O (SD = 5.7) with a significant difference between groups (p less than 0.01). The functional urethral length of the nerve sparing group was 16.7 mm (SD = 5.2) and in the conventional group 13.3 mm (SD = 3.7) with no significant difference between the groups. These results suggest that preservation of neurovascular bundles from the pelvic plexus during radical prostatectomy has no important role in postoperative urinary continence.