Effects of bladder neck sparing on continence outcomes of robotic-assisted radical prostatectomy: a systemic review and metaanalysis

Restoration of postoperative urinary continence after robot-assisted radical prostatectomy (RARP) is affected by diverse factors. We compared the pad-free and positive margin rates of patients who underwent RARP with or without bladder neck sparing (BNS) for prostate cancer. During this systematic review and metaanalysis, we performed an electronic search of the Web of Science, Embase, Cochrane Central Register of Controlled Trials, and PubMed to find original articles comparing RARP with and without BNS for prostate cancer. We identified six studies (2,351 patients in total) who underwent RARP with or without BNS. A metaanalysis of the pad-free rate at 3 months was performed. The overall pad-free rate at 3 months for patients who underwent RARP with BNS was significantly higher than that of patients who underwent RARP alone (control group) (odds ratio, 1.86; 95% confidence interval [CI], 1.22-2.82), with high heterogeneity (P = 0.005; I² = 67.45%). The pad-free rates at 7 days, 6 months, and 1 year and positive surgical margin rates of patients who underwent BNS were not significantly different than those in the control group. Although no statistical difference was observed, the catheterization period of the BNS group was shorter than that of the control group (standardized mean difference = -0.08; 95% CI, -0.16 to 0.01). Although RARP with BNS did not affect the long-term outcome of continence, it had a significant effect on the early recovery of continence.