BLADDER NECK SPARING DURING RADICAL PERINEAL PROSTATECTOMY
RISKS PRESERVING BENIGN PROSTATE GLANDS.

Introduction and Objectives: Bladder neck sparing does not enhance
continence, but does reduce anastomotic tension and may reduce
anastomotic strictures (J. Urol. 158:1470, 1997). We report the risk of
preserving benign prostate tissue with bladder neck sparing.

Materials and Methods: Over 15 months, 60 men, ages 47 to 74 years
(median 66) underwent radical perineal prostatectomy for stage T1c or T2
prostate cancer. PSA ranged from 2.1 to 20.7 ng/ml (median 6.1). Biopsy
Gleason score was 7 or greater in 38% (23/60). Three men had undergone a
prior transurethral resection.
Bladder neck biopsies were not obtained in 7 other men. In the remaining
50 men, biopsies of the preserved bladder neck were obtained prior to
anastomosis.

Results: Small nodules grossly suspicious of retained prostate tissue
were noted on the preserved bladder neck in 2/50 (4%). Both contained
benign prostate glands. One included a focus of adenocarcinoma. Biopsies
of the remaining bladder necks demonstrated focal adenocarcinoma in 1
and microscopic benign glands in 22/50 (44%). Both patients (4%) with
cancer at the bladder neck also had a positive specimen margin at
another site.

Conclusions: This study confirms our findings (J. Urol. 153:1565,1995)
that invasion of the bladder neck by prostate cancer is uncommon and
that it was always associated with additional positive margins.
Therefore, routine wide excision of the bladder neck is usually
unnecessary and futile when it seems necessary. Bladder neck sparing is
associated with a high risk of retaining benign prostate glands. Routine
trimming of the preserved bladder neck is advisable. It is unlikely to
significantly increase anastomotic tension and strictures and it may
reduce the incidence of preserving benign prostate glands.

Vernon E. Weldon, Harry Neuwirth and Patrick M. Bennett, San Rafael, CA.
Presented at the Annual Meeting of the Western Section of the American
Urological Association  

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
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