Abbreviations & AcronymsAbstract: We describe a new technique for urethrovesical anastomosis that consists of placing three "U" stitches of Monocryl 2-0 to connect the bladder neck and urethral stump together. The margins are united by a double passage of the suture, without tying any knots. The sutures are tied on the bladder's surface using Lapra-Ty clips fixed at a certain distance from where to two mucosal margins have been joined. We carried out this technique on 90 patients who underwent laparoscopic extraperitoneal radical prostatectomy. The good joining of the margins, the absence of knots and the minimum trauma to the urethral wall together enable to create an anastomosis that is both "sealed" and "tension free", allowing a quick "welding" of the margins and an early catheter removal. Regarding urinary continence, 56.6% (51) of patients were continent at catheter removal, 87.6% (78) were continent 3 months later and 98.9% (89) were continent after 6 months. In nine patients (10%), an episode of acute urinary retention occurred within 24 h after the removal of the catheter. We did not encounter any cases of vesicourethral anastomosis stenosis.

72 primitive bladder cancer patients pT1G3, 64 males and 8 females, mean age 62.3, underwent T.U.R. or T.V.R. In this series we evaluated the percentage of recurrences, progression and survival, with a follow-up of 10 years. Among 72 patients, 26 showed unifocal lesions and 46 multifocal lesions. In the case of progression, patients underwent radical surgery (cystectomy). After 10 years the 26 patients with unifocal lesions showed a 90% recurrence rate and 56% progression rate, while the 46 patients with multifocal lesions showed 100% recurrence rate and 71% progression rate. A multivariate analysis was done, considering patient age and sex, number of lesions (unifocal or multifocal) and DNA ploidy (diploid/aneuploid). Only the DNA pattern was a determining factor for selecting progression risk cases. PT1 bladder cancers must be considered as invasive forms. Very careful therapeutic evaluation is therefore necessary.

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