Technical description and outcomes of a continuous anastomosis in open radical prostatectomy

Abstract

after ORP in the first 23 patients. The catheter was removed as soon as patients were fully mobile. A validated postal questionnaire to determine continence and its effect on quality of life was sent to all patients ≥ 3 months after ORP. RESULTSThe mean follow-up was 18 months; there were no major complications. There was an insignificant or no leak in 91% of the patients who had a cystogram. Before discharge, 33 patients reported that they were continent, whilst five required a pad(s) for stress incontinence, and one was discharged with a catheter after failing the first catheter removal. Of the 95% who completed the questionnaire, 95% either did not leak urine, or only leaked a small amount; 84% of patients reported that leaking had a minimal effect on everyday life. No patients developed symptomatic urethral or bladder neck stricture/ contracture. CONCLUSIONSOur technique of continuous anastomotic suturing for ORP is safe, reliable and well tolerated. Further randomized studies are warranted to compare the outcome with the standard interrupted vesico-urethral anastomosis.

Incidence of bladder neck contracture after robot‐assisted laparoscopic and open radical prostatectomy

“…The BNC incidence was 2.2% (22 cases) overall, 1.4% (four) for RALP, and 2.6% (18) for ORP ( P = 0.12). Patients with BNC were diagnosed a median (range) of 4.7 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) months after surgery. At 18 months after surgery, the BNC-free rate was 97% for ORP and 99% for RALP (log-rank P = 0.13).…”

“…Technical factors thought to increase BNC include low surgeon volume, absence of mucosal eversion, poor vesicourethral mucosal aposition, urinary extravasation, increased blood loss, ischaemia of the bladder neck/membranous urethra, and excessive narrowing of the urethral anastomosis at the time of the procedure [3,4,6,11,12]. Some surgeons performing ORP have adopted a running anastomosis and achieved low BNC rates [13,14].…”

Comparison of perioperative outcomes between running versus interrupted vesicourethral anastomosis in open radical prostatectomy: A single-surgeon experience

“…Despite the fact that the running suture technique is theoretically more watertight, most surgeons use the interrupted technique because of the difficulty of anastomosis in open RP. Previous studies have shown that using the running suture technique for open RP is technically feasible and permits safe, early catheter removal [ 5 , 6 , 7 , 8 ]. To the best of our knowledge, this is the first study to compare perioperative outcomes of the running and interrupted techniques for RP.…”

“…The running anastomosis is theoretically more watertight and reinserting the catheter is safer and easier, because the catheter tip is less likely to pass posteriorly and extravesically [ 5 ]. Several studies have reported that running anastomosis is technically feasible and provides safe and early catheter removal in open RP [ 5 , 6 , 7 , 8 ]. However, for open RP, most surgeons perform vesicourethral anastomosis by use of interrupted sutures because of the difficulty of anastomosis and the lack of studies comparing outcomes for open RP using running and interrupted techniques.…”

Effect of Continuous Urethro-Vesical Anastomosis Technique in Incontinence After Radical Retropubic Prostatectomy, 1:1 Matching Study

“…Anastomosis site leakage after radical prostatectomy can cause prolonged urethral catheterization periods and complications such as pelvic abscess or the collection of infected fluid [ 1 ]. Prolonged urethral catheterization causes periurethral fibrosis and stricture [ 2 , 3 ], while postprostatectomy incontinence (PPI) can be considered a complication of anastomosis site leakage.…”