Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Urology Reports
Published in: Current Urology Reports 12/2017

Open Access 01-12-2017 | Urosurgery (P Sooriakumaran, Section Editor)

Systematic Review of Studies Reporting Positive Surgical Margins After Bladder Neck Sparing Radical Prostatectomy

Authors: Mariangela Bellangino, Clare Verrill, Tom Leslie, Richard W. Bell, Freddie C. Hamdy, Alastair D. Lamb

Published in: Current Urology Reports | Issue 12/2017

Login to get access

Abstract

Purpose of Review

Bladder neck preservation (BNP) during radical prostatectomy (RP) has been proposed as a method to improve early recovery of urinary continence after radical prostatectomy. However, there is concern over a possible increase in the risk of positive surgical margins and prostate cancer recurrence rate. A recent systematic review and meta-analysis reported improved early recovery and overall long-term urinary continence without compromising oncologic control. The aim of our study was to perform a critical review of the literature to assess the impact on bladder neck and base margins after bladder neck sparing radical prostatectomy.

Evidence Acquisition

We carried out a systematic review of the literature using Pubmed, Scopus and Cochrane library databases in May 2017 using medical subject headings and free-text protocol according to PRISMA guidelines. We used the following search terms: bladder neck preservation, prostate cancer, radical prostatectomy and surgical margins. Studies focusing on positive surgical margins (PSM) in bladder neck sparing RP pertinent to the objective of this review were included.

Evidence Synthesis

Overall, we found 15 relevant studies reporting overall and site-specific positive surgical margins rate after bladder neck sparing radical prostatectomy. This included two RCTs, seven prospective comparative studies, two retrospective comparative studies and four case series. All studies were published between 1993 and 2015 with sample sizes ranging between 50 and 1067. Surgical approaches included open, laparoscopic and robot-assisted radical prostatectomy. The overall and base-specific PSM rates ranged between 7–36% and 0–16.3%, respectively. Mean base PSM was 4.9% in those patients where bladder neck sparing was performed, but only 1.85% in those without sparing.

Summary

Bladder neck preservation during radical prostatectomy may increase base-positive margins. Further studies are needed to better investigate the impact of this technique on oncological outcomes. A future paradigm could include modification of intended approach to bladder neck dissection when anterior base lesions are identified on pre-operative MRI.
Literature
1.
2.
Mottet NJB, Briers E, Bolla, MLB, Cornford P, De Santis M, Henry AMSJ, Lam TB, Mason MD, van der Poel HG, van der Kwast THOR, Wiegel T. EAU-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer 2017.
3.
Montorsi F, Wilson TG, Rosen RC, Ahlering TE, Artibani W, Carroll PR, et al. Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena Consensus Panel. Eur Urol. 2012;62(3):368–81.PubMedCrossRef
4.
Patel VR, Sivaraman A, Coelho RF, Chauhan S, Palmer KJ, Orvieto MA, et al. Pentafecta: a new concept for reporting outcomes of robot-assisted laparoscopic radical prostatectomy. Eur Urol. 2011;59(5):702–7.PubMedCrossRef
5.
Eastham JA, Scardino PT, Kattan MW. Predicting an optimal outcome after radical prostatectomy: the trifecta nomogram. J Urol. 2008;179(6):2207–10. discussion 10-1PubMedCentralPubMedCrossRef
6.
7.
Harris MJ. The anatomic radical perineal prostatectomy: an outcomes-based evolution. Eur Urol. 2007;52(1):81–8.PubMedCrossRef
8.
Gacci M, Carini M, Simonato A, Imbimbo C, Gontero P, Briganti A, et al. Factors predicting continence recovery 1 month after radical prostatectomy: results of a multicenter survey. Int J Urol. 2011;18(10):700–8.PubMedCrossRef
9.
Friedlander DF, Alemozaffar M, Hevelone ND, Lipsitz SR, Hu JC. Stepwise description and outcomes of bladder neck sparing during robot-assisted laparoscopic radical prostatectomy. J Urol. 2012;188(5):1754–60.PubMedCrossRef
10.
Brunocilla E, Schiavina R, Pultrone CV, Borghesi M, Rossi M, Cevenini M, et al. Preservation of the smooth muscular internal (vesical) sphincter and of the proximal urethra for the early recovery of urinary continence after retropubic radical prostatectomy: a prospective case-control study. Int J Urol. 2014;21(2):157–62.PubMedCrossRef
11.
Golabek T, Jaskulski J, Jarecki P, Dudek P, Szopinski T, Chlosta P. Laparoscopic radical prostatectomy with bladder neck preservation: positive surgical margin and urinary continence status. Wideochir Inne Tech Maloinwazyjne. 2014;9(3):362–70.PubMedCentralPubMed
12.
Shelfo SW, Obek C, Soloway MS. Update on bladder neck preservation during radical retropubic prostatectomy: impact on pathologic outcome, anastomotic strictures, and continence. Urology. 1998;51(1):73–8.PubMedCrossRef
13.
Selli C, De Antoni P, Moro U, Macchiarella A, Giannarini G, Crisci A. Role of bladder neck preservation in urinary continence following radical retropubic prostatectomy. Scand J Urol Nephrol. 2004;38(1):32–7.PubMedCrossRef
14.
Srougi M, Nesrallah LJ, Kauffmann JR, Nesrallah A, Leite KR. Urinary continence and pathological outcome after bladder neck preservation during radical retropubic prostatectomy: a randomized prospective trial. J Urol. 2001;165(3):815–8.PubMedCrossRef
15.
Poon M, Ruckle H, Bamshad BR, Tsai C, Webster R, Lui P. Radical retropubic prostatectomy: bladder neck preservation versus reconstruction. J Urol. 2000;163(1):194–8.PubMedCrossRef
16.
Katz R, Salomon L, Hoznek A, de la Taille A, Antiphon P, Abbou CC. Positive surgical margins in laparoscopic radical prostatectomy: the impact of apical dissection, bladder neck remodeling and nerve preservation. J Urol. 2003;169(6):2049–52.PubMedCrossRef
17.
Karakiewicz PI, Eastham JA, Graefen M, Cagiannos I, Stricker PD, Klein E, et al. Prognostic impact of positive surgical margins in surgically treated prostate cancer: multi-institutional assessment of 5831 patients. Urology. 2005;66(6):1245–50.PubMedCrossRef
18.
Watson RB, Civantos F, Soloway MS. Positive surgical margins with radical prostatectomy: detailed pathological analysis and prognosis. Urology. 1996;48(1):80–90.PubMedCrossRef
19.
Stephenson AJ, Wood DP, Kattan MW, Klein EA, Scardino PT, Eastham JA, et al. Location, extent and number of positive surgical margins do not improve accuracy of predicting prostate cancer recurrence after radical prostatectomy. J Urol. 2009;182(4):1357–63.PubMedCrossRef
20.
Mithal P, Howard LE, Aronson WJ, Terris MK, Cooperberg MR, Kane CJ, et al. Positive surgical margins in radical prostatectomy patients do not predict long-term oncological outcomes: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort. BJU Int. 2016;117(2):244–8.PubMedCrossRef
21.
Wright JL, Dalkin BL, True LD, Ellis WJ, Stanford JL, Lange PH, et al. Positive surgical margins at radical prostatectomy predict prostate cancer specific mortality. J Urol. 2010;183(6):2213–8.PubMedCentralPubMedCrossRef
22.
Eggener SE, Scardino PT, Walsh PC, Han M, Partin AW, Trock BJ, et al. Predicting 15-year prostate cancer specific mortality after radical prostatectomy. J Urol. 2011;185(3):869–75.PubMedCentralPubMedCrossRef
23.
Boorjian SA, Karnes RJ, Crispen PL, Carlson RE, Rangel LJ, Bergstralh EJ, et al. The impact of positive surgical margins on mortality following radical prostatectomy during the prostate specific antigen era. J Urol. 2010;183(3):1003–9.PubMedCrossRef
24.
Mauermann J, Fradet V, Lacombe L, Dujardin T, Tiguert R, Tetu B, et al. The impact of solitary and multiple positive surgical margins on hard clinical end points in 1712 adjuvant treatment-naive pT2-4 N0 radical prostatectomy patients. Eur Urol. 2013;64(1):19–25.PubMedCrossRef
25.
Ma X, Tang K, Yang C, Wu G, Xu N, Wang M, et al. Bladder neck preservation improves time to continence after radical prostatectomy: a systematic review and meta-analysis. Oncotarget. 2016;7(41):67463–75.PubMedCentralPubMedCrossRef
26.
Koraitim MM. The male urethral sphincter complex revisited: an anatomical concept and its physiological correlate. J Urol. 2008;179(5):1683–9.PubMedCrossRef
27.
Ahlering TE, Skarecky D, Lee D, Clayman RV. Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol. 2003;170(5):1738–41.PubMedCrossRef
28.
Tewari AK, Rao SR. Anatomical foundations and surgical manoeuvres for precise identification of the prostatovesical junction during robotic radical prostatectomy. BJU Int. 2006;98(4):833–7.PubMedCrossRef
29.
Marcovich R, Wojno KJ, Wei JT, Rubin MA, Montie JE, Sanda MG. Bladder neck-sparing modification of radical prostatectomy adversely affects surgical margins in pathologic T3a prostate cancer. Urology. 2000;55(6):904–8.PubMedCrossRef
30.
Licht MR, Klein EA, Tuason L, Levin H. Impact of bladder neck preservation during radical prostatectomy on continence and cancer control. Urology. 1994;44(6):883–7.PubMedCrossRef
31.
Huang AC, Kowalczyk KJ, Hevelone ND, Lipsitz SR, Yu HY, Plaster BA, et al. The impact of prostate size, median lobe, and prior benign prostatic hyperplasia intervention on robot-assisted laparoscopic prostatectomy: technique and outcomes. Eur Urol. 2011;59(4):595–603.PubMedCrossRef
32.
Gill PS, Roberts IS, Browning L, Perera R, Warren AY, Hamdy FC, et al. The handling and sampling of radical prostatectomy specimens for reporting and research: the Oxford approach. J Clin Pathol. 2012;65(12):1057–61.PubMedCrossRef
33.
Yossepowitch O, Briganti A, Eastham JA, Epstein J, Graefen M, Montironi R, et al. Positive surgical margins after radical prostatectomy: a systematic review and contemporary update. Eur Urol. 2014;65(2):303–13.PubMedCrossRef
34.
Marks RA, Koch MO, Lopez-Beltran A, Montironi R, Juliar BE, Cheng L. The relationship between the extent of surgical margin positivity and prostate specific antigen recurrence in radical prostatectomy specimens. Hum Pathol. 2007;38(8):1207–11.PubMedCrossRef
35.
Emerson RE, Koch MO, Jones TD, Daggy JK, Juliar BE, Cheng L. The influence of extent of surgical margin positivity on prostate specific antigen recurrence. J Clin Pathol. 2005;58(10):1028–32.PubMedCentralPubMedCrossRef
36.
Bianco FJ, Grignon DJ, Sakr WA, Shekarriz B, Upadhyay J, Dornelles E, et al. Radical prostatectomy with bladder neck preservation: impact of a positive margin. Eur Urol. 2003;43(5):461–6.PubMedCrossRef
37.
Chlosta PL, Drewa T, Jaskulski J, Dobruch J, Varkarakis J, Borowka A. Bladder neck preservation during classic laparoscopic radical prostatectomy—point of technique and preliminary results. Wideochir Inne Tech Maloinwazyjne. 2012;7(2):89–95.PubMed
38.
Stolzenburg JU, Kallidonis P, Hicks J, Do M, Dietel A, Sakellaropoulos G, et al. Effect of bladder neck preservation during endoscopic extraperitoneal radical prostatectomy on urinary continence. Urol Int. 2010;85(2):135–8.PubMedCrossRef
39.
Gomez CA, Soloway MS, Civantos F, Hachiya T. Bladder neck preservation and its impact on positive surgical margins during radical prostatectomy. Urology. 1993;42(6):689–93. discussion 93-4PubMedCrossRef
40.
Lee Z, Sehgal SS, Graves RV, Su YK, Llukani E, Monahan K, et al. Functional and oncologic outcomes of graded bladder neck preservation during robot-assisted radical prostatectomy. J Endourol. 2014;28(1):48–55.PubMedCrossRef
41.
Nyarangi-Dix JN, Radtke JP, Hadaschik B, Pahernik S, Hohenfellner M. Impact of complete bladder neck preservation on urinary continence, quality of life and surgical margins after radical prostatectomy: a randomized, controlled, single blind trial. J Urol. 2013;189(3):891–8.PubMedCrossRef
42.
Freire MP, Weinberg AC, Lei Y, Soukup JR, Lipsitz SR, Prasad SM, et al. Anatomic bladder neck preservation during robotic-assisted laparoscopic radical prostatectomy: description of technique and outcomes. Eur Urol. 2009;56(6):972–80.PubMedCrossRef
43.
Tewari A, Sooriakumaran P, Bloch DA, Seshadri-Kreaden U, Hebert AE, Wiklund P. Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur Urol. 2012;62(1):1–15.PubMedCrossRef
44.
Novara G, Ficarra V, Mocellin S, Ahlering TE, Carroll PR, Graefen M, et al. Systematic review and meta-analysis of studies reporting oncologic outcome after robot-assisted radical prostatectomy. Eur Urol. 2012;62(3):382–404.PubMedCrossRef
45.
Wiltz AL, Shikanov S, Eggener SE, Katz MH, Thong AE, Steinberg GD, et al. Robotic radical prostatectomy in overweight and obese patients: oncological and validated-functional outcomes. Urology. 2009;73(2):316–22.PubMedCrossRef
46.
Ginzburg S, Hu F, Staff I, Tortora J, Champagne A, Salner A, et al. Does prior abdominal surgery influence outcomes or complications of robotic-assisted laparoscopic radical prostatectomy? Urology. 2010;76(5):1125–9.PubMedCrossRef
47.
Thompson JE, Egger S, Bohm M, Haynes AM, Matthews J, Rasiah K, et al. Superior quality of life and improved surgical margins are achievable with robotic radical prostatectomy after a long learning curve: a prospective single-surgeon study of 1552 consecutive cases. Eur Urol. 2014;65(3):521–31.PubMedCrossRef
48.
Brausi M. Re: Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Eur Urol. 2017;197(1):151.
49.
Yaxley JW, Coughlin GD, Chambers SK, Occhipinti S, Samaratunga H, Zajdlewicz L, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet. 2016;388(10049):1057–66.PubMedCrossRef
50.
Link BA, Nelson R, Josephson DY, Yoshida JS, Crocitto LE, Kawachi MH, et al. The impact of prostate gland weight in robot assisted laparoscopic radical prostatectomy. J Urol. 2008;180(3):928–32.PubMedCrossRef
51.
Secin FP, Savage C, Abbou C, de La Taille A, Salomon L, Rassweiler J, et al. The learning curve for laparoscopic radical prostatectomy: an international multicenter study. J Urol. 2010;184(6):2291–6.PubMedCentralPubMedCrossRef
52.
Sooriakumaran P, John M, Wiklund P, Lee D, Nilsson A, Tewari AK. Learning curve for robotic assisted laparoscopic prostatectomy: a multi-institutional study of 3794 patients. Minerva Urol Nefrol. 2011;63(3):191–8.PubMed
53.
Chalfin HJ, Dinizo M, Trock BJ, Feng Z, Partin AW, Walsh PC, et al. Impact of surgical margin status on prostate-cancer-specific mortality. BJU Int. 2012;110(11):1684–9.PubMedCrossRef
54.
Pfitzenmaier J, Pahernik S, Tremmel T, Haferkamp A, Buse S, Hohenfellner M. Positive surgical margins after radical prostatectomy: do they have an impact on biochemical or clinical progression? BJU Int. 2008;102(10):1413–8.PubMed
55.
Sooriakumaran P, Dev HS, Skarecky D, Ahlering T. The importance of surgical margins in prostate cancer. J Surg Oncol. 2016;113(3):310–5.PubMedCrossRef
56.
Alkhateeb S, Alibhai S, Fleshner N, Finelli A, Jewett M, Zlotta A, et al. Impact of positive surgical margins after radical prostatectomy differs by disease risk group. J Urol. 2010;183(1):145–50.PubMedCrossRef
Metadata
Title
Systematic Review of Studies Reporting Positive Surgical Margins After Bladder Neck Sparing Radical Prostatectomy
Authors
Mariangela Bellangino
Clare Verrill
Tom Leslie
Richard W. Bell
Freddie C. Hamdy
Alastair D. Lamb
Publication date
01-12-2017
Publisher
Springer US
Published in
Current Urology Reports / Issue 12/2017
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-017-0745-0

Other articles of this Issue 12/2017

Current Urology Reports 12/2017 Go to the issue

New Imaging Techniques (S Rais-Bahrami and A George, Section Editors)

Predictability and Practicality of Image-Based Scoring Systems for Patient Assessment and Outcome Stratification During Percutaneous Nephrolithotomy: a Contemporary Update

Benign Prostatic Hyperplasia (K McVary, Section Editor)

Aquablation of the Prostate for Symptomatic Benign Prostatic Hyperplasia: Early Results

Benign Prostatic Hyperplasia (K McVary, Section Editor)

Holmium Laser Enucleation of the Prostate: Patient Selection and Outcomes

New Imaging Techniques (S Rais-Bahrami and A George, Section Editors)

Spatial Tracking of Targeted Prostate Biopsy Locations: Moving Towards Effective Focal Partial Prostate Gland Ablation with Improved Treatment Planning

New Imaging Techniques (S Rais-Bahrami and A George, Section Editors)

HistoScanningTM to Detect and Characterize Prostate Cancer—a Review of Existing Literature

New Imaging Techniques (S Rais-Bahrami and A George, Section Editors)

A Review of Imaging Modalities Used in the Diagnosis and Management of Scrotal Trauma