Prostate surgery approach may reduce incontinence

NEW YORK (Reuters Health) - Surgery that avoids disturbing the nerves during the removal of the prostate gland -- a "nerve-sparing" approach to radical prostatectomy -- shortens the period until continence is regained and improves the long-term continence rates for most patients, new research shows.

Previous studies have shown that preservation of the cluster of nerves around the prostate, the "neurovascular bundle," can reduce the risk of impotence after surgery, but whether the technique reduces incontinence rates has been less clear, senior author Dr. Craig D. Zippe, from the Cleveland Clinic Foundation, and colleagues note in their report, which is published in the medical journal Urology.

To investigate, the researchers assessed incontinence rates in 152 men who underwent radical prostatectomy with nerve-sparing on one side, both sides, or with no attempt at nerve sparing.

The radical form of the surgery, usually conducted in men with prostate cancer, as opposed to non-cancerous prostate disease, involves the complete removal of the gland. During these surgeries, it is often difficult not to injure the nerves surrounding the prostate.

After an average follow-up period of 7.8 years, 27 patients (17.7 percent) patients were incontinent.

Eighteen of 61 patients treated with non-nerve-sparing surgery were incontinent compared with just 6 of 66 men who underwent nerve-sparing surgery on both sides - a statistically significant difference.

However, the surgical approach that only partially preserved the nerves offered no benefits over surgery that did not spare the nerves at all.

In addition to the type of surgery, patient age also affected incontinence rates; men who were older than 65 years were significantly more likely to become incontinent than were younger patients.

These findings suggest that, whenever medically feasible, all men may benefit from nerve-sparing prostate surgery, the authors conclude.

SOURCE: Urology, December 2007.