Introduction: We sought to evaluate the impact of bladder neck preservation in men undergoing RALP with regard to operative, pathological, and functional outcomes.

Methods: From a contemporary series of over 280 men undergoing RALRP, we evaluated 60 consecutive men who underwent a BNS procedure who had at least 6 months of post-operative follow-up to determine short-term clinical and functional results. These men were compared to 60 consecutive men (also >6 months follow-up) who underwent a conventional (non-BNS) approach. The impact of this modification on clinical, peri-operative, pathological, and functional outcome was analyzed.

Results: No differences were observed with regard to age, BMI, PSA or EBL. Of note, operative times were significantly shorter in the BNS group (336 hrs. vs. 3.75 hrs), and this substantiates our observation that BNS significantly simplifies and expedites the BN dissection, especially posteriorly. With regard to pathological and functional outcomes, positive margins trended lower in the BNS (vs. non-BNS) group (6.7% vs. 15.0%). Note, no patient in the BNS subgroup had a positive margin at the base. Erectile function (classified as successful erections with/without oral meds in patients who were potent preoperatively) also trended higher in the BNS group (76% vs. 53%). 6-month pad use was lower in the BNS subgroup: any pad (10% vs. 20%), >1pad (0% vs. 3%).

Conclusion: BNS procedure during RALRP seems to expedite the procedure without any compromise to surgical and pathological outcomes.6-month continence rates seems to favor patients having a BNS procedure.