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Laparoscopic “single knot–single running” suture vesico-urethral anastomosis with posterior musculofascial reconstruction

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Abstract

Purpose

To describe results of a simplified technique to configure the vesicourethral anastomosis and to restore posterior musculofascial plate during laparoscopic radical prostatectomy with a “single knot–single running” suture.

Methods

Between December 2006 and 2009, a conventional Van Velthoven anastomosis (group A) was applied in 125 cases while the novel anastomosis was applied in 155 consecutive patients (group B). A between group comparison of continence recovery was performed with log-rank test and Chi-square test. Continuous variables were compared with Wilcoxon’s test and categorical ones with Chi-square test.

Results

Median operative time and median time to configure the anastomosis were comparable between two groups. Proportions of patients using 0 pad, 1 pad and >1 pad per day were statistically different between groups at 1 month (54.4%, 14.4%, 31.2% vs. 52.3%, 27.7%, 20%, in group A and group B, respectively; p = 0.01), at 3 months (73.6%, 8.8%, 17.6% vs. 86.5%, 7.1%, 6.5%; p = 0.01) and at 6 months (80.8%, 12.8%, 6.4% vs. 92.3%, 6.5%, 1.2%; p = 0.01). At log-rank test, continence recovery between two groups was statistically different (p = 0.008).

Conclusions

The excellent outcome together with the easiness of performing this novel anastomosis compared to the traditional Van Velthoven make it widely reproducible.

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References

  1. Schuessler WW, Shulam PG, Clayman RV, Kavoussi LR (1997) Laparoscopic radical prostatectomy: initial short term experience. Urology 50:854–857

    Article  PubMed  CAS  Google Scholar 

  2. Van Velthoven RF, Ahlering TE, Peltier A, Skarecky DW, Clayman RV (2003) Technique for laparoscopic running urethrovesical anastomosis: the single knot method. Urology 61:699–702

    Article  PubMed  Google Scholar 

  3. Rocco F, Carmignani L, Acquati P et al (2007) Early continence recovery after open radical prostatectomy with restoration of the posterior aspect of the rhabdosphincter. Eur Urol 52:376–383

    Article  PubMed  Google Scholar 

  4. Rocco B, Gregori A, Stener S et al (2007) Posterior reconstruction of the rhabdosphincter allows a rapid recovery of continence after transperitoneal videolaparoscopic radical prostatectomy. Eur Urol 51:996–1003

    Article  PubMed  Google Scholar 

  5. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  Google Scholar 

  6. Wei J, Dunn R, Litwin M, Sandler H, Sanda M (2000) Development and validation of the Expanded Prostate Cancer Index Composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology 56:899–905

    Article  PubMed  CAS  Google Scholar 

  7. Naselli A, Simone G, Papalia R et al. (2011) Late-onset incontinence in a cohort of radical prostatectomy patients. Int J Urol. doi:10.1111/j.1442-2042.2010.026666

  8. Walz J, Burnett AL, Costello AJ et al (2010) A critical analysis of the current Knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy. Eur Urol 57:179–192

    Article  PubMed  Google Scholar 

  9. Steiner MS (1994) The puboprostatic ligament and the male urethral suspensory mechanism: an anatomic study. Urology 44:530–534

    Article  PubMed  CAS  Google Scholar 

  10. Burnett AL, Mostwin JL (1998) In situ anatomical study of the male urethral sphincteric complex: relevance to continence preservation following major pelvic surgery. J Urol 160:1301–1306

    Article  PubMed  CAS  Google Scholar 

  11. Presti JC Jr, Schmidt RA, Narayan PA, Carroll PR, Tanagho EA (1990) Pathophysiology of urinary incontinence after radical prostatectomy. J Urol 143:975–978

    PubMed  Google Scholar 

  12. Poore RE, McCullough DL, Jarow JP (1998) Puboprostatic ligament sparing improves urinary continence after radical retropubic prostatectomy. Urology 51:67–72

    Article  PubMed  CAS  Google Scholar 

  13. Deliveliotis C, Protogerou V, Alargof E, Varkarakis J (2002) Radical prostatectomy: bladder neck preservation and puboprostatic ligament sparing—effects on continence and positive margins. Urology 60:855–858

    Article  PubMed  CAS  Google Scholar 

  14. Takenaka A, Hara R, Soga H, Murakami G, Fujisawa M (2005) A novel technique for approaching the endopelvic fascia in retropubic radical prostatectomy, based on an anatomical study of fixed and fresh cadavers. BJU Int 95:766–771

    Article  PubMed  Google Scholar 

  15. Takenaka A, Soga H, Sakai I, Nakano Y, Miyake H, Tanaka K, Fujisawa M (2009) Influence of nerve-sparing procedure on early recovery of urinary continence after laparoscopic radical prostatectomy. J Endourol 23:1115–1119

    Article  PubMed  Google Scholar 

  16. Licht MR, Klein EA, Tuason L, Levin H (1994) Impact of bladder neck preservation during radical prostatectomy on continence and cancer control. Urology 44:883–887

    Article  PubMed  CAS  Google Scholar 

  17. Jenkins LC, Nogueira M, Wilding GE et al (2008) Median lobe in robotassisted radical prostatectomy: evaluation and management. Urology 71:810–813

    Article  PubMed  Google Scholar 

  18. Freire MP, Weinberg AC, Lei Y et al (2009) Anatomic bladder neck preservation during robotic-assisted laparoscopic radical prostatectomy: description of technique and outcomes. Eur Urol 56:972–980

    Article  PubMed  Google Scholar 

  19. Joshi N, de Blok W, van Muilekom E, van der Poel H (2010) Impact of posterior musculofascial reconstruction on early continence after robot-assisted laparoscopic radical prostatectomy results of a prospective parallel group trial. Eur Urol 58:84–89

    Article  PubMed  Google Scholar 

  20. Rehder P, Gozzi C (2007) Transobturator sling suspension for male urinary incontinence including post-radical prostatectomy. Eur Urol 52:860–866

    Article  PubMed  Google Scholar 

  21. Rehder P, Freiin von Gleissenthall G, Pichler R et al (2009) The treatment of post-prostatectomy incontinence with the retroluminal transobturator repositioning sling (AdVance): lessons learnt from accumulative experience. Arch Esp Urol 62:860–870

    Article  PubMed  Google Scholar 

  22. Patel VR, Coelho RF, Palmer KJ, Rocco B (2009) Periurethral suspension stitch during robot-assisted laparoscopic radical prostatectomy: description of the technique and continence outcomes. Eur Urol 56:472–478

    Article  PubMed  Google Scholar 

  23. Tewari AK, Bigelow K, Rao S et al (2007) Anatomic restoration technique of continence mechanism and preservation of puboprostatic collar: a novel modification to achieve early urinary continence in men undergoing robotic prostatectomy. Urology 69:726–731

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Urology, “Regina Elena” National Cancer Institute, Via Chianesi 53, 00144, Rome, Italy

    Giuseppe Simone, Rocco Papalia, Mariaconsiglia Ferriero, Salvatore Guaglianone & Michele Gallucci

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  1. Giuseppe Simone
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  2. Rocco Papalia
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  3. Mariaconsiglia Ferriero
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  4. Salvatore Guaglianone
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  5. Michele Gallucci
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Correspondence to Giuseppe Simone.

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Simone, G., Papalia, R., Ferriero, M. et al. Laparoscopic “single knot–single running” suture vesico-urethral anastomosis with posterior musculofascial reconstruction. World J Urol 30, 651–657 (2012). https://doi.org/10.1007/s00345-012-0840-2

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  • DOI: https://doi.org/10.1007/s00345-012-0840-2

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