Analysis of three different vesicourethral anastomotic techniques in laparoscopic radical prostatectomy.

OBJECTIVES: 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.
MATERIALS AND METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.