Endoscopic bladder neck incision as first step in radical prostatectomy: An aid for patients previously treated for bladder outlet obstruction

OBJECTIVES: Some patients with the indication of radical prostatectomy (RP) have often undergone previous surgical treatment for bladder outlet obstruction (BOO). These previous treatments make oncological surgery more challenging because of the difficulty in the identification of bladder neck and ureteral orifices. We present a new technique that entails previous endoscopic marking of bladder neck in order to make radical prostatectomy easier. METHODS: Twelve men with previous prostatic surgery for BOO underwent a laparoscopic/robotic radical prostatectomy between August 2008 and October 2012. The same technique was performed in all cases, a first circular endoscopic incision (EI) to mark the bladder neck and a second laparoscopic/robotic approach to complete the RP. We analyzed oncological and functional outcomes, as well as complications. RESULTS: Median operative time (EI + RP) was 175 minutes (140-205), being surgical time for endoscopic approach 20 minutes (17-31). No ureteral lesions were described and no ureteral stents were required. Positive margin rate was 8.3%. Only 1 of 5 complications observed needed surgery to be solved. Continence rate was 66.7% at one year of surgery. CONCLUSIONS: Our results show that a previous endoscopic bladder neck incision in patients with previous surgery for BOO makes easier the identification and dissection of the bladder neck itself during radical prostatectomy decreasing the risk of ureteral lesions as well as improving functional outcomes.