Analysis of three different vesicourethral anastomotic techniques in laparoscopic radical prostatectomy

The vesicourethral anastomosis is critical to the outcome of laparoscopic radical prostatectomy (LRP). We retrospectively compared a recently introduced running suture with existing interrupted techniques.

A total of 600 patients undergoing LRP at our institution were reviewed. Each group consisted of 200 patients. Group 1 (intracorporeal-single-knot-running suture) was compared to cohorts in whom the anastomosis was created by interrupted suturing, with (group 2) or without (group 3) a previously placed 6 o'clock suture. Intraoperative data and cystographic evaluation were collected prospectively. Detailed analysis of the location of extravasation was correlated with duration of leak. At a median follow up of 26 months, continence and stricture rates were assessed.

The groups were statistically similar with respect to age, prostate volumes and pre-operative PSA. Numbers of patients undergoing lymphadenectomy and/or nerve-sparing procedures were also similar between groups. The median time for anastomosis was significantly shorter for group 1 (15.3 min) compared to group 2 (23.5 min) and group 3 (27.7 min) (P < 0.000.1). This was reflected in the overall operative times [group 1; 155.4 min, group 2; 185.6 min and group 3; 202.2 min (P = 0.03)]. Subjective assessment suggested that tension to the anastamosis was present in fewer patients in group 1 (3.5%) compared to group 2 (17%) and group 3 (9.5%) (P = 0.001). There was no significant difference in the continence or stricture rate between the three groups.

The continuous anastomotic suture reduced the operative time and tension to the anastomosis. However, the long term continence and stricture rates were unaffected by anastomotic technique.