OBJECTIVES To evaluate the difference in outcome of bladder neck contracture (BNC) and its causes between large groups of patients undergoing open radical prostatectomy (ORP) and robot‐assisted laparoscopic prostatectomy (RALP). PATIENTS AND METHODS We analysed 200 consecutive RPs performed by one surgeon for prostate cancer, 100 by ORP and 100 by RALP, between March 2003 and September 2007. The operative techniques of bladder neck repair and urethro‐vesical anastomosis were different. The ORP patients had a conventional stomatization and ‘racquet handle’ repair of the bladder if necessary, with mucosal eversion and a direct circular interrupted ‘end‐to‐end’ suture anastomosis between the bladder and urethra. The RALP patients had no bladder neck reconstruction or mucosal eversion and their anastomosis was by the continuous suture ‘parachute’ technique. RESULTS There was no BNC in the RALP group, whilst 9% of the ORP group developed a BNC (P < 0.005). Apart from surgical technique, other variables, including patient age, previous transurethral resection of the prostate, Gleason score, T stage, urine infection rate, urinary leakage, blood loss, drain tube removal, anastomotic suture material, catheter type and catheter removal times were statistically comparable in both groups. CONCLUSION This series suggests that the major factor involved in the cause of bladder neck contracture after ORP, relates to the stomatization or ‘racquet handle’ bladder neck repair, and the end‐to‐end anastomosis between the urethra and stomatized bladder. Mucosal eversion might also contribute. Normal postoperative urinary leakage when the anastomotic apposition is good seems unlikely to be a significant aetiological factor in the development of BNC. Prolonged urinary leakage results from an anastomotic gap, which heals by second intention, thereby causing scarring and BNC. The RALP ‘parachute’ technique, which expands the anastomosis towards the bladder, appears to protect against BNC. Mucosal eversion is not necessary in the parachute repair.

Introduction: Fetal abdominal circumference (AC) is utilised in calculations for the estimation of fetal weight (EFW) and has been proposed as a method of monitoring diabetic pregnancies. We evaluated true ultrasound accuracy by comparing fetal AC biometry with neonatal anthropometry and compared this with standard ultrasound estimations of fetal weight. Methods: A prospective observational study was performed at a tertiary referral centre. Women who were having their confinement of a term, singleton gestation either by induction of labour or elective caesarean section from 2009–2011 were approached to participate. An ultrasound was performed within 24 hours of delivery measuring the biometric parameters of AC, head circumference (HC), biparietal diameter and femur length. Following delivery the AC, HC and birthweight were measured on the neonate. Results: Fifty‐two patients were enrolled in the study with data collected from 50. Mean AC measurement was 35.1 ± 2.1 cm and birth weight was 3596 ± 517 g. A Bland‐Altman plot was used to compare the two AC measurements with the 95% limits of agreement ranging from −2.33–4.69 cm around a mean difference of 1.2 cm. Mean percentage error was 5.0% and 6.2% for the AC and HC measurements respectively, in comparison with percentage errors of 7.0–13.8% for estimation of fetal weight (EFW) from 27 formulae. Conclusions: Sonographic AC measurement is accurate in term pregnancies, with a percentage error less than HC or EFW. Perceptions of ultrasound inaccuracy may relate to the application of formulae rather than the ultrasound technique itself. Fetal surveillance using serial AC measurement has been proposed, in particular monitoring of diabetic pregnancies and in such a group AC may be easier and faster to obtain and more meaningful than EFW.

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error of estimated fetal weight was 238 g (absolute range 3 g-855 g, real range −855 g-792 g), with a mean absolute percentage error of 6.7% (absolute range 0.08%-21%, real range −21% −20%). Twenty three infants (6.6%) had a birth weight < 10 th centile when matched for gestation, including three infants with a birth weight < 2.5 kg. The mean error in estimated fetal weight in these infants was 6.3%. Forty seven infants (13.4%) had a birth weight > 90 th centile. The mean error in estimated fetal weight in this group was −4.7%. Conclusions: Ultrasound determined estimated fetal weight performed just prior to labour shows a strong correlation with birth weight. In this study we observed an overestimation of birth weight in small for gestational age infants, and an underestimation of birth weight in large for gestational age infants. The incidence of undiagnosed small for gestational age neonates in this study was greater than 1:20, confirming the difficulty in identifying these babies by clinical assessment alone.

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