Radical retropubic prostatectomy with running vesicourethral anastomosis and early catheter removal: Our experience

Abstract

Objectives: To assess the outcomes of patients undergoing radical retropubic prostatectomy (RRP) with a running vesicourethral anastomosis and catheter removal on postoperative day 3 or 5. Methods: From February 2006 through December 2007, 55 patients underwent RRP at our institution. All procedures were performed by a single surgeon using a running suture for the vesicourethral anastomosis. A cystogram was carried out before catheter removal in all patients. The initial 23 of 55 patients (Group 1; n = 23) had the cystogram on postoperative day 5, the other 32 patients (Group 2; n = 32) had the cystogram on postoperative day 3. Removal of the catheter was only carried out if there was no anastomotic extravasation. Results: The success rate of catheter removal in group 1 and 2 was 100% and 96.9%, respectively. Overall continence rates were 83.3%, 87% and 90.7% at 24, 48 and 72 h after removal of the catheter, respectively. There was no significant difference in terms of continence rate between groups 1 and 2. None of the patients had acute urinary retention and/or anastomotic stricture after catheter removal. Conclusions: These findings suggest that an advanced running vesicourethral anastomosis during RRP is technically feasible, allowing safe early catheter removal in most patients.

Outcome of nephrostomy balloon dilation for vesicourethral anastomotic strictures following radical prostatectomy: a retrospective study

“…In addition, we found that the incidence of anastomotic strictures was significantly higher in patients with an anastomosis constructed by the interrupted suture technique than in those with the running suture technique. This finding is consistent with those reported by Ozu et al .,6 who found that the use of running sutures in these patients is safer compared with the use of four to six interrupted sutures, allowing safe early catheter removal in most patients. We speculate that the running suture technique decreases prolonged anastomotic urinary leakage and bleeding, which may lead to local ischemia or blood clot accumulation, delay mucosa healing and result in urinary extravasation.…”

“…Currently, various procedures exist for managing anastomotic strictures25678 after radical prostatectomy, including single sounds or balloon dilation, cold knife incision, transurethral resection or internal urethrotomy with a Holmium laser. However, none of these methods is universally accepted due to the relatively high recurrence rate.…”

Running suture versus interrupted suture for vesicourethral anastomosis in retropubic radical prostatectomy: A randomized study

“…2). 9 After eversion of the bladder mucosa with bladder neck preservation, an anchoring suture was placed at the 6 o'clock position 5 mm posterior to the bladder neck using 3-0 poliglecaprone (3-0 Monocryl, SH, 90 cm, double-armed needle). A one-sided needle was driven from outside-in to the bladder mucosa at the 5 o'clock position; it passed the 5 o'clock position of the urethral stump with an inside-out full-thickness suture.…”

Modified posterior musculofascial plate reconstruction decreases the posterior vesicourethral angle and improves urinary continence recovery in patients undergoing laparoscopic radical prostatectomy

“…The middle of the running suture was secured with several LAPRA-TY ® clips (Ethicon Inc., Bridgewater, NJ, USA). We attempted to push the needles thinly through the anterior urethra (15) and anchor them to the fascia covering the DVC to avoid laceration of the urethra. The double-armed running sutures were finally ligated at the anterior side of the urethra.…”