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Anastomosis quality score during robot-assisted radical prostatectomy: a new simple tool to maximize postoperative management

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Abstract

Purpose

The urethro-vesical anastomosis represents one of the most challenging steps of robotic prostatectomy (RARP). To maximize postoperative management, we specifically designed our anastomosis quality score (AQS), based on the intraoperative characteristics of the urethra and bladder neck.

Methods

This is a prospective study, conducted from April 2019 to March 2020. All the patients were classified into three different AQS categories (low, intermediate, high) based on the quality of the anastomosis. The postoperative management was modulated accordingly.

Results

We enrolled 333 patients. According to AQS, no differences were recorded in intraoperative complications (p = 0.9). Median hospital stay and catheterization time were longer in AQS 1 group (p < 0.001). Additionally, the occurrence of postoperative complication was higher in AQS 1 category (p = 0.002) but, when focusing on the complications related to the quality of the anastomosis, no differences were found neither for acute urinary retention (p = 0.12) nor urine leakage (p = 0.11). Finally, concerning the continence recovery, no significant differences were found among the three groups for each time point. The highest potency recovery rate at one month of follow-up was recorded in AQS 3 category (p = 0. 03).

Conclusion

The AQS proposed revealed to be a valid too to intraoperatively categorize patients who underwent RARP on the basis of the urethral and bladder neck features.

The modulated postoperative management for each specific score category allowed to limit the occurrence of complications and to maximize the functional outcomes.

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Author information

Author notes

  1. Francesco Porpiglia and Enrico Checcucci contributed equally to the first authorship.

  2. Matteo Manfredi and Cristian Fiori contributed equally to the senior authorship.

Authors and Affiliations

  1. Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy

    Francesco Porpiglia, Enrico Checcucci, Sabrina De Cillis, Daniele Amparore, Angela Pecoraro, Alberto Piana, Stefano Granato, Paolo Verri, Michele Sica, Federico Piramide, Matteo Manfredi & Cristian Fiori

  2. Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy

    Enrico Checcucci

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  1. Francesco Porpiglia
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Contributions

FP: Project development, supervision of manuscript writing. EC: Manuscript writing, data analysis. SDC: Data collection, data analysis. DA: Data analysis, drawings. AP: Data analysis. AP: Data collection. SG: Data collection. PV: Manuscript writing. MS: Data collection. FP: Data collection. MM: Data analysis, supervision of manuscript writing. CF: Project development, supervision of manuscript writing.

Corresponding author

Correspondence to Enrico Checcucci.

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All the authors have nothing to declare.

Ethical approval

This is an observational study. In accordance with AIFA (Agenzia Italiana del Farmaco) Guidelines for Observational Studies, no institutional review board or ethical committee approval was required.

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Informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided informed consent for publication of the images in Fig. 1a–c.

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Porpiglia, F., Checcucci, E., De Cillis, S. et al. Anastomosis quality score during robot-assisted radical prostatectomy: a new simple tool to maximize postoperative management. World J Urol 39, 2921–2928 (2021). https://doi.org/10.1007/s00345-020-03549-6

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  • DOI: https://doi.org/10.1007/s00345-020-03549-6

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