IMPACT OF INTRAOPERATIVE BLEEDING ON URINARY CONTINENCE RECOVERY AFTER BILATERAL NERVE
SPARING RADICAL PROSTATECTOMY
L. Villa*, N.Fossati*, N.Passoni*, G.Gandaglia*, D.Di Trapani*, R.Bertini*, R.Damiano**, F.Cantiello**, P.Dell'Oglio*,
V.Mirone***, G.Zanni*, A.Gallina*, G.Guazzoni*, F.Montorsi*, A.Briganti*
(*) Ospedale San Raffaele, Urology Unit, Milan, Italy
(**) Urology Unit and Doctorate Research Program, Magna Græcia University of Catanzaro, Catanzaro, Italy
(***) Department of Urology, University of Naples Federico II, Naples, Italy
SCOPO DEL LAVORO:
Although several pre- and intra-operative factors have been associated with functional recovery after nerve sparing radical
prostatectomy (NSRP), conflicting results have been reported regarding the role of intraoperative bleeding on postoperative UC
recovery
MATERIALI E METODI:
The study included 665 patients affected by prostate cancer (PCa) submitted to retropubic NSRP between January 2005 and December
2011 at a single referral tertiary center. All patients had complete data, including PSA at diagnosis, age at surgery, body mass index
(BMI) and preoperative erectile function (EF) assessed by the International Index of Erectile Function (IIEF). Patients were classified
according to intraoperative bleeding in two groups according to median value of blood loss: patients with blood loss<700 ml (n=
304,45.7%) vs ≥700 ml (n= 361,54.3%). After surgery, functional data were recorded every three months during the first year and
every 6 months thereafter. UC recovery was defined as being completely pad-free over a 24-hour period. Kaplan-Meier curves
assessed the time to UC recovery in the overall population and according to intraoperative bleeding. Univariable and multivariable
Cox regression analyses addressed predictors of UC recovery after surgery
RISULTATI:
At a mean follow up of 36.4 months (median 35), 452 patients (68%) recovered UC. Overall, postoperative UC recovery rate at 1 and
2 years were 66% and 70.4%, respectively. The mean intraoperative blood loss was 820 ml (median 700 ml). At 1- and 2-year
analysis, UC recovery rates were significantly lower in patients with intraoperative bleeding ≥700 ml as compared to those with a
blood loss<700 ml (63.4 vs. 70.5% and 67vs74.7%, respectively; p=0.04).These results were confirmed at multivariable analyses,
where age at surgery and blood loss represented the only predictors of UC recovery after surgery (p=0.006 and p=0.009, respectively)
even after accounting for confounders (i.e., preoperative erectile function, BMI, pathological stage and preoperative PSA). Patients
with a blood loss <700 ml had a 1.4-fold higher probability of being fully continent after NSRP as compared to those with a bleeding
≥700 ml (p<0.01).
DISCUSSIONE:
Intraoperative bleeding significantly affects UC recovery after NSRP. Bleeding might lead to pelvic ischemia and/or to a worse
visualization of the operative field, which in turn might affect the quality of surgery.
CONCLUSIONI:
Minimally invasive approaches associated with lower blood bloss might thus be beneficial in the context of functional outcomes.