Eur Urol Suppl 2007;6(2):55 129 ThE ROlE OF blAddER NECk PRESERvATION dURINg RAdICAl PROSTATECTOMY: UROdYNAMIC ANd ClINICAl STUdY Grasso M. 1 , Torelli F. 1 , Lania C. 2 , Blanco S. 1 1 Desio Hospital, Urology, Desio, Italy, 2 San Rafaele Hospital, Urology, Milan, Italy Introduction & Objectives: Bladder neck preservation has caused an increase in urinary continence following radical prostatectomy, and has given rise to much controversy. We have reviewed our surgical and urodynamic experience collected since 1995 in patients subjected to radical prostatectomy with bladder neck preservation. Material & Methods: 180 patients were followed postoperatively using a pad test, an incontinence questionnaire and PSA dosage. In 66 continent patients, test of maximum urethral closing pressure, functional length and active urethral continence were carried out, together with Valsalva leak point pressure tests and a pressure/fow study. The obtained data were analysed. Results: Urinary continence was achieved in 132/180 men (73%) already two weeks after operation. Three months, six months and one year later the continence rate was 89%, 95.5% and 97.7% (176/180) respectively. As far as the urodynamic parameters of the 66 patients fully tested are concerned, all showed high results. The active urethral continence capacity exceeded 200cm/water, and the Valsalva leak point pressure equalled or exceeded 150cm/water. Two Weeks Three Months Six Months Twelve Months (no/pad) (no/pad) (no/pad) no/pad 73 % 89 % 95.5 % 97.7 % Continence Recovery Conclusions: When following an accurate dissection of the distal urethra, bladder neck preservation guarantees early recovery of continence, as confrmed by local urodynamic fgures, and restores functional integration of both the urethral sphincteric-smooth proximal and distal striated units. 130 ThE IMPACT OF EARlY URINARY dRAINAgEAT ThE UREThROvESICAl ANASTOMOSIS ON ThE dEvElOPMENT OF blAddER NECk CONTRACTURE AFTER RAdICAl RETROPUbIC PROSTATECTOMY Tokuc R., Basok E., Basaran A., Gocer S., Ilhan A.I. SB Istanbul Goztepe Training and Research Hospital, Department of Urology, Istanbul, Turkey Introduction & Objectives: Radical retropubic prostatectomy (RRP) is an accepted treatment of localized prostate cancer. Despite refnements in surgical technique, anastomotic contracture is a well recognized long-term complication of RRP. We aim to defne the role of early post-operative urinary drainage at urethravesical anastomosis on the development of bladder neck contracture. Material & Methods: Between January 2000 and June 2006, a total of 170 consecutive patients (median age 62 years, range 44-73) with localized prostate cancer underwent RRP, using a modifed anatomic approach described by Walsh. One hundred-fourteen patients were available for the follow-up. In all patients, urethral catheter was removed 3 weeks after surgery without a cystogram. Post- operatively, we record the volume of early urinary drainage and how many days the urinary drainage lasts. We evaluated the impact of the early urinary leakage at the urethrovesical anastomosis on the development of bladder neck contracture. Results: The patients were assessed in respect to the development of the anastomotic contracture according to the volume of urinary drainage and the days of urinary drainage. Therefore, we classifed patients into separate 2 groups according to drainage days (1 st group: < 3 days, n= 75; 3-5 days, n= 28 and > 5 days, n= 11) and drainage volume (2 nd group: < 300 ml, n= 67; 300-500 ml, n= 20 and > 500 ml, n= 27). The median follow-up was 33 months (range 6 – 70 months), during 32 patients (28%) developed some degree of bladder neck contracture. There were bladder neck contracture in 9 (12%), 17 (60%) and 6 (55%) patients in 1 st group (drainage days), respectively (p<0.05). Bladder neck contracture occurred in 11 (16%), 7 (35%) and 14 (52%) patients in 2 nd group (drainage volume), respectively (p<0.05). Conclusions: The amount and the time (days) of urinary drainage at the urethrovesical anastomosis were signifcantly associated with the development of anastomotic contracture following radical retropubic prostatectomy. O4 OUTCOME OF RAdICAl PROSTATECTOMY 2 Wednesday, 21 March, 14.30-16.00, Room 3 131 dISTRIbUTION OF ExCISEd PERIPhERAl NERvE TISSUE ON RAdICAl PROSTATECTOMY SPECIMEN’S NERvE SPARINg ASPECT Sievert K.D., Hennenlotter J., Laible I., Merseburger A., Anastasiadis A., Nagele U., Kuehs U., Kuczyk M., Stenzl A. University of Tübingen, Urology, Tübingen, Germany Introduction & Objectives: In nerve sparing (NS) radical prostatectomy (RP) the preserved nerves can preserve patients’ sexual function and continence. However, postoperative data demonstrates that insufciency of nerve protection and anatomical conditions are under present investigation. The question arose, whether and where peripheral nerval tissue adjacent to the RP specimen is excised in NS RP. The aim of this study was to evaluate the distribution and local quantity of peripheral nerval tissue left at the NS aspect of the RP specimen. Material & Methods: From 10 patients unilateral NS, RP specimens were analysed microscopically using PGP 9.5 stained whole mounted serial sections. Dividing the prostate half into 12 sectors (each ventral – ventrolateral – dorsolateral - dorsal and apex – mid - base, respectively), sectorwise counts of periprostatic nerves, rationed into small and big (>500 microns), were performed. Mean values of the NS aspect were demonstrated as a percentage share against the respective corresponding contralateral non-NS sector. Results: In unilateral NS in total a 54% and 56% (big/small) share in nerval tissue versus contralateral was noted; only in the dorsolateral position was the reduction to 17/44% signifcant (p<0.001). Table I demonstrates the percentage share against the respective corresponding contralateral non-NS sector for the 12 locations as well as for row and column sums for big and small nerves, respectively (big / small). Apical big%/small% Mid Part big%/small% Basal big%/small% Total big%/small% Ventral 33/83 63/101 100/98 63/97 Ventrolateral 259/112 200/94 84/52 134/71 Dorsolateral 10/18 18/38 25/71 17/44 Dorsal 42/64 424/83 64/40 113/54 Total 29/39 78/62 51/63 54/56 %=Percentage in comparison of the contralateral side Conclusions: A considerable amount of periprostatic nerval tissue remains on the RP specimen’s NS aspect. In the anterior part and at the dorsal surface of the prostate, only marginal NS is noted and in particular to a diferent extent, along the base to apex direction with lack of continuity of the preserved nerve fbers - essential for functionality. NS is performed predominantly along the dorsolateral track and is strongest in the apical region, resulting in a superior total NS result apical with partial abandonment of this result basalward. These fndings may contribute to an improvement of nerve sparing surgery. 132 RAdICAl PERINEAl PROSTATECTOMY – A SINglE INSTITUTION STUdY ON PROSPECTIvElY CONTROllEd RESUlTS IN A CONSECUTIvE SERIE OF 1600 CASES Goetz T., Neugart F., Groh R., Jung H., Horsch R. Klinikum Ofenburg, Urology, Ofenburg, Germany Introduction & Objectives: This report on radical perineal prostatectomy (RPP) summarizes our large experience and prospectively controlled results of this operative technique of treatment of localized prostate cancer. Material & Methods: Between 9/1995 and 10/2006, 1600 men underwent RPP (Young`s technique) by 8 surgeons. The entire inpatients records and the follow–up results were prospectively analysed. Patients with a higher risk of pelvic lymphnode metastases ≥ 5% (Partin tables) or Gleason sum > 3+4 were lymphadenectomized by laparoscopy (LPL) before RPP. Urinary continence was checked by questionnaire and pad test. Results: Mean age of patients was 65 years (42-77), mean PSA of all men (LPL- patients incl.) was 11,4 ng/ml (0,1 -255) and 8,4 ng/ml (0,1 – 139) respectively in men without LPL. The LPL group had a mean PSA of 17,3ng/ml (0,5 – 255). The pathological stages were diferentiated in pT2 (71,6%), pT3a (14,7%), pT3b (6,8%) and pT4 (6,8%). The mean Gleason sum was 6,0 (2 - 9), the operating time 100min (50 – 233) and the blood loss 2,0 g/dl (0 – 7,2).The last 1200 patients didn`t require any blood transfusion. Positive margins over all pathological stages were found in 24,4% (pT2 :13,9%). They were located at the urethra in 14,5%, the bladder neck in 16,8%, the apex in 41,9% and at the lateral lobes in 62,4% of the cases.The urinary continence rates (no pads) reached at hospital discharge 51,2% and 93% after 12 months.Nerve sparing surgery (NSS) were performed unilaterally in 17,6% (since 2004 19,6%) and bilaterally in 20,8% (since 2004 44,4%) of the cases. The number of anastomotic strictures (1,3%), rectal lesions (2,3%) and passing neuropraxia (1,2%) were comparable to other approaches in radical prostatectomy. Biochemical recurrence over all pathological stages was seen in 29,6% (pT2 : 13,8%) of the cases with a mean follow-up of 90 months. Conclusions: Our large series demonstrate that in the hands of experienced surgeons RPP is associated with very minimal intra and postoperative morbidity. Our results suggests that RPP cannot be assumed to have greater morbidity than laparoscopic radical prostatectomy. The perineal approach is less invasive than the retropubic technique. It also entails less discomfort as well as low costs.