TCRM_A_278454 1289..1296

Purpose To compare running suture (RS) and interrupted suture (IS) of vesicourethral anastomosis (VUA) during open retropubic radical prostatectomy (RRP) on early urinary continence and extravasation. Patients and Methods Single center analysis of 211 patients who underwent RRP performed by a single surgeon during 2008 to 2017 was retrospectively analyzed. For VUA, we used the standard interrupted suture technique (n=100) with a 3–0 PDS suture. The RS (n=111) was performed with 12-bite suture using 3–0 PDS. The primary endpoints were extravasation and early continence. Demographic and peri-operative data were collected and analyzed using Pearson’s chi-square, t-Test and Mann–Whitney U-test. A binary logistic regression analysis was carried out to explore predictors that affected early continence after catheter removal. Results The rates of early urinary incontinence (UI) were 7.7% vs 42.2% (p<0.001). The duration of catheterization and hospitalization was significantly shorter in the interrupted group (4 days vs 5 days, p<0.001 and 5 days vs 6 days, p<0.001). The groups did not differ significantly in body mass index or prostate volume. There were older patients and higher PSA levels in the group with RS technique. No significant difference was found in the postoperative extravasation rates between both groups (13.5% vs 12%, p=0.742). Conclusion Running vesicourethral anastomosis increased the rate of early urinary incontinence. Both anastomosis techniques provided a similar rate of postoperative urine extravasation. VUA should only be one of the many criteria that must be considered for the preservation of urinary continence of patients after RRP.

[1]  J. Moul,et al.  Interrupted versus Continuous Suturing for Vesicourethral Anastomosis During Radical Prostatectomy: A Systematic Review and Meta-analysis. , 2019, European urology focus.

[2]  A. Kretschmer,et al.  [Stricture of the vesicourethral anastomosis after radical prostatectomy]. , 2018, Der Urologe (Ausg. A).

[3]  F. Nickel,et al.  Interrupted versus continuous suturing for vesicourethral anastomosis during radical prostatectomy: protocol for a systematic review and meta-analysis , 2017, BMJ Open.

[4]  K. Brasso,et al.  Anastomotic complications after robot-assisted laparoscopic and open radical prostatectomy , 2016, Scandinavian journal of urology.

[5]  S. Jeon,et al.  Effect of Continuous Urethro-Vesical Anastomosis Technique in Incontinence After Radical Retropubic Prostatectomy, 1:1 Matching Study , 2015, International neurourology journal.

[6]  Ju Hyun Lim,et al.  Comparison of perioperative outcomes between running versus interrupted vesicourethral anastomosis in open radical prostatectomy: A single-surgeon experience , 2015, Korean journal of urology.

[7]  H. Matsuyama,et al.  Running suture versus interrupted suture for vesicourethral anastomosis in retropubic radical prostatectomy: A randomized study , 2015, International journal of urology : official journal of the Japanese Urological Association.

[8]  M. Puntoni,et al.  Age Is Predictive of Immediate Postoperative Urinary Continence after Radical Retropubic Prostatectomy , 2013, Urologia Internationalis.

[9]  G. Chatellier,et al.  Does the use of a barbed polyglyconate absorbable suture have an impact on urethral anastomosis time, urethral stenosis rates, and cost effectiveness during robot-assisted radical prostatectomy? , 2013, Urology.

[10]  H. G. van der Poel,et al.  Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. , 2012, European urology.

[11]  J. J. Juan Escudero,et al.  Use of a barbed suture for the urethro-vesical anastomosis during the learning curve of the endoscopic extraperitoneal radical prostatectomy. , 2012, Archivos españoles de urología.

[12]  A. Haese*,et al.  Full functional-length urethral sphincter preservation during radical prostatectomy. , 2011, European urology.

[13]  R. Herwig,et al.  Urinary continence after radical prostatectomy: the patient perspective. , 2011, The Canadian journal of urology.

[14]  N. Simforoosh,et al.  Early continence after open and laparoscopic radical prostatectomy with sutureless vesicourethral alignment: an alternative technique, 8 years' experience. , 2009, Urology journal.

[15]  A. Shalhav,et al.  Continued improvement of perioperative, pathological and continence outcomes during 700 robot-assisted radical prostatectomies. , 2009, The Canadian journal of urology.

[16]  I. Varkarakis,et al.  Reducing the number of sutures for vesicourethral anastomosis in radical retropubic prostatectomy. , 2009, International braz j urol : official journal of the Brazilian Society of Urology.

[17]  D. Teber,et al.  Analysis of three different vesicourethral anastomotic techniques in laparoscopic radical prostatectomy , 2008, World Journal of Urology.

[18]  R. Autorino,et al.  Vesicourethral anastomosis during radical retropubic prostatectomy: does the number of sutures matter? , 2007, Urology.

[19]  Jin‐Young Jang,et al.  Pancreatic fistula after pancreaticoduodenectomy: a comparison between the two pancreaticojejunostomy methods for approximating the pancreatic parenchyma to the jejunal seromuscular layer: interrupted vs continuous stitches. , 2006, World journal of gastroenterology.

[20]  I. Tuerk,et al.  Progression of laparoscopic radical prostatectomy: improved outcomes with the extraperitoneal approach and a running anastomosis. , 2006, Journal of endourology.

[21]  A. Morabito,et al.  Restoration of posterior aspect of rhabdosphincter shortens continence time after radical retropubic prostatectomy. , 2006, The Journal of urology.

[22]  W. Dillenburg,et al.  Vesicourethral anastomosis during endoscopic extraperitoneal radical prostatectomy: a prospective comparison between the single-knot running and interrupted technique. , 2006, Urology.

[23]  J. Thüroff,et al.  Technical advances in radical retropubic prostatectomy techniques for avoiding complications. Part II: vesico‐urethral anastomosis and nerve‐sparing prostatectomy , 2003, BJU international.

[24]  Ralph V Clayman,et al.  Technique for laparoscopic running urethrovesical anastomosis:the single knot method. , 2003, Urology.

[25]  M. Litwin,et al.  Urinary function and bother after radical prostatectomy or radiation for prostate cancer: a longitudinal, multivariate quality of life analysis from the Cancer of the Prostate Strategic Urologic Research Endeavor. , 2000, The Journal of urology.

[26]  P. Walsh Anatomic radical prostatectomy: evolution of the surgical technique. , 1998, The Journal of urology.

[27]  T. Kneib,et al.  Preservation of putative continence nerves during radical retropubic prostatectomy leads to more rapid return of urinary continence. , 1998, Urology.

[28]  R. Ferrigni,et al.  Comparison of the modified vest and the direct anastomosis for radical retropubic prostatectomy. , 1997, Urology.

[29]  M. Steiner The puboprostatic ligament and the male urethral suspensory mechanism: an anatomic study. , 1994, Urology.

[30]  J. Goellner,et al.  Prostate shape, external striated urethral sphincter and radical prostatectomy: the apical dissection. , 1987, The Journal of urology.

[31]  P. Walsh,et al.  An anatomical approach to the surgical management of the dorsal vein and Santorini's plexus during radical retropubic surgery. , 1979, The Journal of urology.