Reducing the number of sutures for vesicourethral anastomosis in radical retropubic prostatectomy

Abstract

Objectives: To prospectively evaluate the outcome of using a two-suture technique for the vesicourethral anastomosis (VUA) during radical retropubic prostatectomy (RRP). Materials and Methods: Two groups of 50 patients each underwent nerve-sparing RRP for localized prostate cancer by one surgeon. In one group, the vesicourethral anastomosis was performed using 2 Vicryl 2-0 stitches placed at the 3-and 9-o'clock positions and in the other group 6 Vicryl 2-0 stitches were placed at the 2-, 4-, 6-, 8-, 10-and 12-o'clock positions. The intraoperative and perioperative parameters analyzed were time to perform the VUA, time to remove the drain and hospitalization. The rate of incontinence, anastomotic stricture and erectile function were included in the outcome analysis. Results: The anastomotic time differed statistically between the 2 groups (mean 3.3 minutes for the 2-suture group and 10.5 minutes for the 6-suture group, p < 0.0001) with similar periods of drain removal (mean 3.12 days for the 2-suture group and 3.45 days for the 6-suture group; p = 0.13) and hospitalization (mean 4.66 days for the 2-suture group and 5.3 days for the 6-suture group; p = 0.09). The functional outcome was excellent for the 2-suture group with no patient suffering from incontinence or anastomotic strictures 1 year postoperatively, while in the 6-suture group there were 2 patients (4%) suffering from incontinence (2 underwent sling procedure) and 1 patient suffered from anastomotic stricture. Conclusion: The low number of sutures in the 2-suture VUA technique reduces operating times, does not influence perioperative and intraoperative parameters and results in excellent functional outcome.

Improving early urinary continence recovery after radical prostatectomy by applying a sutureless technique for maximal preservation of the intrapelvic urethra: A 17-year single-surgeon experience

“…Nevertheless, a significantly shorter mean time of anastomosis was observed in the group of patients with two sutures in comparison with patients with four and six sutures. In line with the previously mentioned study, Mazaris et al 27 also observed no significant difference in 1-year continence rate, urinary leakage, mean drain removal time, and mean time of hospital stay between patients undergoing nerve-sparing radical retropubic prostatectomy using two and six sutures. However, the mean time to VUA was significantly shorter in the group with two sutures compared to the six-suture group.…”

Radical perineal prostatectomy and early continence: outcomes after 120 cases

“…external urinary sphincter. Vesicourethral anastomosis is performed with running or interrupted sutures in RPs (4,11,20).…”

Interrupted versus Continuous Suturing for Vesicourethral Anastomosis During Radical Prostatectomy: A Systematic Review and Meta-analysis

“…In the early days of RP, the vest technique was used to shift tension from the anastomotic site to the perineum [6]. Other studies compared a two-stitch VUA versus a fourstitch or six-stitch VUA [7,8]. Simforoosh et al [9] even presented a study reporting on a suture-less VUA.…”