To evaluate early continence rates with a novel modified vesico-urethral anastomosis technique based on prevention of urethral retraction using anastomosis sutures as stay sutures (PURS) during robot-assisted radical prostatectomy.
The modified anastomosis technique was used in 60 patients and data collected prospectively. This cohort was compared with another consecutive 60 patients operated with standard anastomosis technique. This new technique is based on preventing urethral retraction of the posterior urethra with 2 anastomosis sutures being used as stay sutures. The outcomes were prospectively followed and groups compared regarding early continence. International Consultation on Incontinence Questionnaire Short Form (ICIQSF) was used to assess incontinence and its impact on the quality of life. Pad use (yes or no pads) was evaluated as a more stringent criterion.
Preoperative patient characteristics were similar between the two groups. Anastomosis was completed faster in PURS group (15.1 vs. 18.5 min, p=0.05). At postoperative week 1 and month 1, the severity and bother of incontinence was significantly less in the PURS group (12.7 vs. 4.1 and 10.1 vs. 2.6, p<0.001). PURS cohort reported significantly superior pad-free rates at both postoperative month 1 (73% vs. 35%, p<0.0001) and month 3 (83% vs. 53%, p=0.0004) On multivariable analysis, younger age and the new anastomosis technique were two independent predictors to improve early continence. Four patients in modified anastomosis group (4/60) and 1 in standard anastomosis group (1/60) necessitated temporary urethral recatheterization due to urinary retention.
We describe a simple and time efficient modified urethrovesical anastomosis technique by using anastomosis sutures as stay sutures to prevent perineal retraction of the urethral stump. Our results demonstrated that the technique is an independent factor impacting on early recovery of urinary continence. Future randomized controlled studies would be required to further test the reproducibility of this technique.
Journal of endourology. 2017 Nov 21 [Epub ahead of print]
Omer Burak Argun, Mustafa Bilal Tuna, Tünkut Doğanca, Can Obek, Panagiotis Mourmouris, Ilter Tufek, Sarper Erdogan, Bulent Cetinel, Ali Riza Kural
Acibadem University, School of Medicine, Department of Urology, Istanbul , Turkey ; ., Acibadem Maslak Hospital , Department of Urology, Istanbul, Turkey ; ., Acibadem Taksim Hospital, Department of Urology, Istanbul, Turkey ; ., Acibadem Taksim Hospital, Department of Urology, Istanbul, Turkey ; ., 2nd Urology Department, Athens medical School, Sismanogleio General Hospital, University of Athens, Department of Urology, Athens, Greece ; ., Acibadem University, School of Medicine, Department of Urology, Istanbul, Turkey ; ., University of Istanbul, Cerrahpasa School of Medicine, Public Health, Istanbul, Turkey ; ., Istanbul University, Cerrahpasa School of Medicine, Department of Urology, Istanbul, Turkey ; ., Acibadem University, School of Medicine, Department of Urology, Istanbul , Turkey ; .