Introduction: Vesico-urethral anastomosis (VUA) represents a challenging step of Open Radical Prostatectomy (ORP) because of limitation of space in the depth of men’s pelvis, lack of control on knots during tightening and subsequent inadequate coupling of VUA or breakdown of knots and extremely difficult reapplication of sutures. To facilitate this step of RP we have developed a simple and reproducible technique and report our 8 years' experience.
Technique: We used two extra-long DeBakey tissue forceps to approximate the bladder neck to the urethral stump. We found it more beneficial than Babcock clamp especially in obese patients with excess fatty tissue in pelvic area. Using this technique surgeon's assistant can sweep the fatty tissue away from anastomotic area and make more space for surgeon’s hand and push the reconstructed bladder neck down while the sutures are being tied.
Results: We analyzed data from 200 patients with prostatic cancer who underwent Open Radical Prostatectomy performed from 2009 to 2017. There were only 2 sutures disrupted during knot tying. In two cases (1%) drain output was more than 30 mL/day on postoperative day 2 and drainage was left in place longer. The goal of urinary full continence (0- 1 pad/day) has been achieved in 85%, 94% and 98%of patients immediately after catheter removal, 3 months and 6 months after surgery, respectively by adding medications, time voiding and dedicated pelvic floor exercise if needed. Eight patients (4%) developed urethral stricture.
Conclusion: The surgical technique has been shown as independent predictors of urinary continence. We introduce a new simple modification of Vesico-urethral anastomosis during RP. Using this technique; in addition to decrease in anastomotic disruption rate and increasing knot tying control, may affect postoperative urinary continence after ORP.
VUA (Vesico-urethral anastomosis) , ORP (Open Radical Prostatectomy) , RP (Radical Prostatectomy)
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