Preservation of Putative Continence Nerves during Radical Retropubic Prostatectomy Leads to More Rapid Return of Urinary Continence

Objectives. Urinary incontinence is a significant complication of radical pelvic surgery. A better understanding of the neuroanatomy of the rhabdosphincter has led to the modification of the radical retropubic prostatectomy to optimize the recovery of postoperative urinary control. Methods. Mock rad...

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Published in:	Urology (Ridgewood, N.J.) Vol. 51; no. 6; pp. 960 - 967
Main Authors:	Hollabaugh, Robert S, Dmochowski, Roger R, Kneib, Timothy G, Steiner, Mitchell S
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Inc 01-06-1998 Elsevier Science
Subjects:	Biological and medical sciences Cadaver Fundamental and applied biological sciences. Psychology Humans Male Medical sciences Middle Aged Prostatectomy - adverse effects Prostatectomy - methods Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the urinary system Time Factors Urethra - innervation Urinary Incontinence - epidemiology Urinary Incontinence - etiology Urinary Incontinence - prevention & control Vertebrates: urinary system Human Urinary system disease Pathophysiology Urinary tract disease Anatomy Urinary incontinence Voiding dysfunction Surgery Pelvis pathology Decision aid Complication Prostatectomy Bladder disease Cadaver
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Summary:	Objectives. Urinary incontinence is a significant complication of radical pelvic surgery. A better understanding of the neuroanatomy of the rhabdosphincter has led to the modification of the radical retropubic prostatectomy to optimize the recovery of postoperative urinary control. Methods. Mock radical retropubic prostatectomy was performed on fresh cadavers to determine which surgical maneuvers could injure what may be the continence nerves. To assess the clinical significance of modifying the radical retropubic prostatectomy based on these anatomic studies, a contemporary series of 60 consecutive patients who underwent radical retropubic prostatectomy with continence nerve preservation was compared with a control group of 38 consecutive patients who had a standard anatomic radical retropubic prostatectomy. Results. At the level of the prostatic apex, both the pelvic and pudendal nerves gave intrapelvic branches that bilaterally coursed to the external urinary sphincter to enter at the 5 and 7 o’clock positions. The mock radical prostatectomy revealed that the nerves to the external urinary sphincter were most prone to injury when a right angle clamp was used to develop a plane between the posterior rhabdosphincter and anterior rectum and if the urethral anastomotic sutures were placed at the 5 and 7 o’clock positions. In addition, blunt dissection of the tips of the seminal vesicles injured the inferior hypogastric plexus. Modifications to preserve the continence nerves were incorporated in the anatomic radical prostatectomy. Although overall continence rates were similar for the two groups (98.3% for continence nerve-preserving radical prostatectomy versus 92.1% for standard prostatectomy), continence nerve preservation decreased the time to achieve continence. Conclusions. During radical retropubic prostatectomy, surgical maneuvers that avoid injury to the continence nerves resulted in the more rapid return of urinary control.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	0090-4295 1527-9995
DOI:	10.1016/S0090-4295(98)00128-9