A comparative study on the operative outcomes of a novel technique of continuous versus interrupted vesicourethral anastomosis in open radical retropubic prostatectomy.
- Author:
Martinez Marlon P.
;
Bisnar Carlo C.
;
Letran Jason L.
- Publication Type:Journal Article
- MeSH: Human; Male; Aged; Middle Aged; Neoplasms; Prostatic Neoplasms; Anastomosis, Surgical; Prostatectomy
- From: Philippine Journal of Urology 2014;24(1):18-26
- CountryPhilippines
- Language:English
-
Abstract:
OBJECTIVE: Vesicourethral anastomosis (VUA) is the most technically challenging part in open radical retropubic prostatectomy (ORRP). Traditionally, it is accomplished using interrupted anastomotic sutures. The objective of this study is to describe our surgical technique of continuous VUA and compare its outcomes with that of interrupted VUA as performed by a single surgeon.
MATERIALS AND METHODS: A total of 235 patients with clinically localized prostate cancer who underwent ORRP since February 2000 to June 2013 were included. They were divided into Group 1 (n=121) using interrupted VUA and Group 2 (n=114) using our technique of continuous VUA. Primary outcome measures to be evaluated include several operative parameters with respect to operative time, blood loss, anastomotic integrity, hospital stay, continence, potency and occurrence of VUA stenosis. Analysis was done using Welch's t-test and Fisher's exact test. All the statistical tests were performed using SPSS 20.0. P-values less than 0.05 indicate statistically significant difference.
RESULTS: Patients who underwent continuous VUA (Group 2) had significantly less operative time (210.05 ± 1.91 vs 251.37 ± 2.74 mins, P<0.001), anastomotic time (20.86 ± 0.49 vs 41.46 ± 0.58 mins, P<0.001), estimated blood loss (510.81 ±10.11 vs 623.89 ±26.60 ml, P<0.001), need for transfusion (7.89% vs 27.27%, P<0.001), number of days prior to drain removal (3.13 ± 0.05 vs 6.15 ± 0.11, P<0.001), number of days of hospital stay (3.44 ± 0.06 vs 6.36 ± 0.11, P<0.001), leakage per voiding cystourethrogram (0.88% vs 5.76%, P=0.035), number of days prior to urethral catheter removal (10.05 ± 0.12 vs 14.94 ± 0.2, P<0.001) and number of weeks to gain continence (7.05 ± 0.26 vs 12.46 ± 0.31, P<0.001). There were two cases of VUA stenosis for each of the two groups. There was no reported occurrence of pelvic infection, urinoma and acute urinary retention after catheter removal.
CONCLUSIONS: Our technique of continuous VUA for ORRP provides better outcome compared to standard interrupted VUA.