A Pragmatic Randomized Trial Comparing Suturing Techniques for Vesicourethral Anastomosis: One-Year Voiding Function...

Background: Vesicourethral anastomosis (VUA) is a critical step in radical prostatectomy (RP), with interrupted suture (IS) and running suture (RS) as common techniques. However, there is no conclusive evidence suggesting the superiority of one technique over the other regarding voiding function. This study compares their effects on voiding function and continence recovery after retropubic RP. Methods: A two-group, parallel-design study included 70 patients with localized prostate cancer (pT1-pT2) undergoing retropubic RP by a single surgical team. Patients were randomized to VUA with IS (n = 35) or RS (n = 35). The primary outcomes included uroflowmetry parameters-maximum flow rate (MFR), voiding volume (VV)-post-void residual volume (PVR), urinary function assessed by the International Prostate Symptom Score (IPSS), and continence recovery. These outcomes were measured preoperatively and at 1, 3, 6, and 12 months post-surgery. Secondary outcomes included surgical parameters, perioperative complications and one-year oncological outcomes. Results: Suturing time was shorter for RS than IS (21 vs. 33 min, p = 0.001). Minimal anastomotic leakage occurred more frequently in the IS group (23% vs. 9%), while long-term anastomotic stenosis rates were comparable between RS and IS groups (12% vs. 9%). IS demonstrated significantly higher MFR at 1-month post-surgery (23.3 vs. 17.2 mL/s, p = 0.003). In subsequent follow-ups (3, 6, and 12 months), the mean MFR remained higher in the IS group, though without statistical significance. Logistic regression favored IS for early MFR outcomes (OR 4.16; 95% CI, 1.22-14.18; p = 0.023). Continence recovery and IPSS scores were similar between groups. Conclusions: Both techniques are effective and safe. RS reduces suturing time and leakage risk, while IS improves early postoperative MFR.