A Comparative Study on the Operative Outcomes of a Novel Technique of Continuous Versus Interrupted Vesicourethral Anastomosis in Open Radical Retropubic Prostatectomy

A Comparative Study on the Operative Outcomes of a Novel Technique of Continuous Versus Interrupted Vesicourethral Anastomosis in Open Radical Retropubic Prostatectomy
PropertyValue
Title:A Comparative Study on the Operative Outcomes of a Novel Technique of Continuous Versus Interrupted Vesicourethral Anastomosis in Open Radical Retropubic Prostatectomy
Author/Abstract:

Marlon P. Martinez, MD; Carlo C. Bisnar, MD, FPUA and Jason L. Letran, MD, FPUA
Section of Urology, Department of Surgery, University of Santo Tomas Hospital

Objective: Vesicourethral anastomosis (VUA) is the most technically challenging part in open radical retropubic prostatectomy (ORRP).
Traditionally, it is accomplished using interrupted anastomotic sutures. The objective of this study is to describe our surgical technique
of continuous VUA and compare its outcomes with that of interrupted VUA as performed by a single surgeon.

Materials and Methods: A total of 235 patients with clinically localized prostate cancer who underwent ORRP since February 2000 to June
2013 were included. They were divided into Group 1 (n=121) using interrupted VUA and Group 2 (n=114) using our technique of continuous VUA.
Primary outcome measures to be evaluated include several operative parameters with respect to operative time, blood loss, anastomotic
integrity, hospital stay, continence, potency and occurrence of VUA stenosis. Analysis was done using Welch’s t-test and Fisher’s exact
test. All the statistical tests were performed using SPSS 20.0. P-values less than 0.05 indicate statistically significant difference.

Results: Patients who underwent continuous VUA (Group 2) had significantly less operative time (210.05 ± 1.91 vs 251.37 ± 2.74 mins,
P<0.001), anastomotic time (20.86 ± 0.49 vs 41.46 ± 0.58 mins, P<0.001), estimated blood loss (510.81 ±10.11 vs 623.89 ±26.60 ml, P<0.001),
need for transfusion (7.89% vs 27.27%, P<0.001), number of days prior to drain removal (3.13 ± 0.05 vs 6.15 ± 0.11, P<0.001), number of
days of hospital stay (3.44 ± 0.06 vs 6.36 ± 0.11, P<0.001), leakage per voiding cystourethrogram (0.88% vs 5.76%, P=0.035), number of days
prior to urethral catheter removal (10.05 ± 0.12 vs 14.94 ± 0.2, P<0.001) and number of weeks to gain continence (7.05 ± 0.26 vs 12.46 ±
0.31, P<0.001). There were two cases of VUA stenosis for each of the two groups. There was no reported occurrence of pelvic infection,
urinoma and acute urinary retention after catheter removal.

Conclusions: Our technique of continuous VUA for ORRP provides better outcome compared to standard interrupted VUA.

Key words: continuous vesicourethral anastomosis, prostate cancer, and open radical retropubic prostatectomy

Filesize: 1.71 MB
Filetype:pdf (Mime Type: application/pdf)