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

Abstract

Abbreviations & Acronyms CI = confidence interval EPIC = Expanded Prostate Cancer Index Composite HR = hazard ratio IS = interrupted suture POD = postoperative day PSA = prostate-specific antigen QOL = quality of life RARP = robot-assisted radical prostatectomy RRP = retropubic radical prostatectomy RS = running suture VUAS = vesicourethral anastomotic stenosis Objectives: To determine the feasibility of vesicourethral anastomosis using running suture during retropubic radical prostatectomy and to compare the surgical outcomes of vesicourethral anastomosis using running suture with those of the standard interrupted suture technique. Methods: A total of 60 patients undergoing radical prostatectomy from 2010 to 2012 at the Yamaguchi University Hospital, Japan were included in the present study, and were randomly assigned to vesicourethral anastomosis using running suture (n = 30 patients) or a standard interrupted suture technique group (n = 30 patients). Vesicourethral anastomosis using running suture was carried out with 12-bite sutures using 3-0 poliglecaprone. The primary end-point was the time to catheter removal. Patients' health-related quality of life was assessed using the Expanded Prostate Cancer Index Composite in 56 patients (28 patients in each group). Results: No significant difference was found in the median suturing time between the two study groups (both 19 min, P = 0.449). The time to catheter removal was significantly better in the vesicourethral anastomosis using running suture group (hazard ratio 5.23, 95% confidence interval 1.73-17.65, P = 0.003). The pad-free rate was significantly higher in the vesicourethral anastomosis using running suture group at 1 month after surgery (20.7% vs 3.3%, P = 0.0463); however, there was no significant difference at 3 months and beyond. The Expanded Prostate Cancer Index Composite urinary and bowel summary scores at 1 month were significantly better in the vesicourethral anastomosis using running suture patients (both P < 0.01), though no significant difference was observed thereafter. A vesicourethral anastomosis stricture was noted in three patients (10%) in the standard interrupted suture technique group, and none in the vesicourethral anastomosis using running suture group. Conclusion: Running suture for vesicourethral anastomosis is feasible during retropubic radical prostatectomy. Furthermore, it offers better outcomes than the conventional standard interrupted suture technique, with a higher likelihood of improvement in patients' healthrelated quality of life. Correspondence

Description of the Open Anterograde Anatomic Radical Retropubic Prostatectomy Technique

“…Therefore, the drainage volume was low, similar to the good results observed for length of hospital stay (mean of 3.4 days, range 3−5 days depending primarily on suction drain volume) and bladder catheterization. These improvements in recovery-related outcomes are benefits of the anterograde technique that have been previously reported for video-assisted surgery; however, the present study is the first to report consistent findings using the same surgical procedure with an open technique [11,13,[18][19][20][21]. In this series, the catheter was typically removed 1 week after surgery.…”

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

“…No significant differences in surgical and functional outcomes were found except a reduction in anastomotic time in the barbed suture groups. The introduction of barbed sutures boosted the use of CS; however, IS continues to be used yet at some hospitals [13,33].…”

“…The systematic literature search retrieved 2021 studies, of which nine studies (1417 patients) were included for the systematic review and meta-analysis [25][26][27][28][29][30][31][32][33]. Detailed information on the screening process is illustrated in the PRISMA flow diagram ( Fig.…”

“…Risk of bias in the included studies, assessed with the NOS, revealed heterogeneous quality ranging from five to eight stars. Only the RCT by Matsuyama et al [33] adequately reported on loss of follow-up (Table 1).…”

Early Continence and Extravasation After Open Retropubic Radical Prostatectomy – Interrupted vs Continuous Suturing for Vesicourethral Anastomosis

“…10 Other studies compared IS and RS for VUA in laparoscopic RP, but there are only a few studies evaluating both suture techniques in open RRP. [11][12][13] While data about mid-and long-term continence rates are available, studies about early continence rates after RP are rare. In consequence, the aim of the present study was to report data on early continence in patients undergoing open RRP and compare perioperative outcomes of the two anastomosis suture approaches.…”