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

Abstract

Nora Köhler, Nasrin El-Bandar, Andreas Maxeiner, Bernhard Ralla, Kurt Miller, Jonas Busch,* Frank Friedersdorff* Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität Zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany*These authors contributed equally to this workCorrespondence: Frank Friedersdorff Tel [phone]Fax [phone]Email [email protected]: To compare running suture (RS) and interrupted suture (IS) of vesicourethral anastomosis (VUA) during open retropubic radical prostatectomy (RRP) on early urinary continence and extravasation.Patients and Methods: Single center analysis of 211 patients who underwent RRP performed by a single surgeon during 2008 to 2017 was retrospectively analyzed. For VUA, we used the standard interrupted suture technique (n=100) with a 3– 0 PDS suture. The RS (n=111) was performed with 12-bite suture using 3– 0 PDS. The primary endpoints were extravasation and early continence. Demographic and peri-operative data were collected and analyzed using Pearson’s chi-square, t-Test and Mann–Whitney U-test. A binary logistic regression analysis was carried out to explore predictors that affected early continence after catheter removal.Results: The rates of early urinary incontinence (UI) were 7.7% vs 42.2% (p< 0.001). The duration of catheterization and hospitalization was significantly shorter in the interrupted group (4 days vs 5 days, p< 0.001 and 5 days vs 6 days, p< 0.001). The groups did not differ significantly in body mass index or prostate volume. There were older patients and higher PSA levels in the group with RS technique. No significant difference was found in the postoperative extravasation rates between both groups (13.5% vs 12%, p=0.742).Conclusion: Running vesicourethral anastomosis increased the rate of early urinary incontinence. Both anastomosis techniques provided a similar rate of postoperative urine extravasation. VUA should only be one of the many criteria that must be considered for the preservation of urinary continence of patients after RRP.Keywords: retropubic prostatectomy, vesicourethral anastomosis, suturing technique, continence, tightness

Keywords

• retropubic prostatectomy
• vesicourethral anastomosis
• suturing technique
• continence
• tightness