To compare the postoperative tissue damage and longitudinal changes in functional and patient-reported outcomes after vesicourethral anastomosis with barbed suture and nonbarbed suture in robot-assisted laparoscopic radical prostatectomy (RARP).
Materials and methods
This was a prospective cohort study involving 88 consecutive patients who underwent RARP. These patients were categorized into the barbed suture group (n = 50) and the nonbarbed suture group (n = 38). Urethral and periurethral damages determined by magnetic resonance imaging at nine months after RARP were compared using generalized linear models. The International Prostate Symptom Score (IPSS), quality of life (QOL) index, uroflowmetry, and the 1-h pad test were measured at baseline and at 1, 3, 6, 9, and 12 months after RARP. The findings were analyzed using mixed-effects models. Confounding was adjusted for using propensity score covariate adjustment.
The likelihood of having Grade 2/3 urethral and periurethral damages was greater in the barbed suture group than in the nonbarbed suture group (adjusted risk ratios: 2.98 and 3.85, respectively). IPSS, QOL index, and urinary leakage transiently increased at one month after RARP in both groups. QOL index was higher in the barbed suture group than in the nonbarbed suture group at 1, 9, and 12 months (P = 0.023, P = 0.025, and P = 0.011, respectively). The barbed suture group had significantly more cases of urinary incontinence than the nonbarbed suture group at 3 months (P = 0.041). Other outcomes were comparable between the two groups at all time points.
This cohort study showed that, after RARP, barbed sutures during VUA induced more severe tissue damage as determined by MRI and greater transient aggravation of QOL and continence function than nonbarbed sutures. The present findings suggest that using nonbarbed sutures during VUA may facilitate earlier acquisition of urinary QOL and urinary continence.
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Li H, Liu C, Zhang H et al (2015) The use of unidirectional barbed suture for urethrovesical anastomosis during robot-assisted radical prostatectomy: a systematic review and meta-analysis of efficacy and safety. PLoS ONE 10:e0131167
Zorn KC, Trinh QD, Jeldres C et al (2012) Prospective randomized trial of barbed polyglyconate suture to facilitate vesico-urethral anastomosis during robot-assisted radical prostatectomy: time reduction and cost benefit. BJU Int 109:1526
Williams SB, Alemozaffar M, Lei Y et al (2010) Randomized controlled trial of barbed polyglyconate versus polyglactin suture for robot-assisted laparoscopic prostatectomy anastomosis: technique and outcomes. Eur Urol 58:875
Sammon J, Kim TK, Trinh QD et al (2011) Anastomosis during robot-assisted radical prostatectomy: randomized controlled trial comparing barbed and standard monofilament suture. Urology 78:572
Sakata S, Kabir S, Petersen D et al (2015) Are we burying our heads in the sand? Preventing small bowel obstruction from the V-loc(R) suture in laparoscopic ventral rectopexy. Colorectal Dis 17:O180
Oor J, de Castro S, van Wagensveld B (2015) V-loc capable of grasping surrounding tissue causes obstruction at the jejunojejunostomy after Roux-en-Y laparoscopic gastric bypass. Asian J Endosc Surg 8:209
Sammon J, Petros F, Sukumar S et al (2011) Barbed suture for renorrhaphy during robot-assisted partial nephrectomy. J Endourol 25:529
Paparel P, Akin O, Sandhu JS et al (2009) Recovery of urinary continence after radical prostatectomy: association with urethral length and urethral fibrosis measured by preoperative and postoperative endorectal magnetic resonance imaging. Eur Urol 55:629
Tuygun C, Imamoglu A, Keyik B et al (2006) Significance of fibrosis around and/or at external urinary sphincter on pelvic magnetic resonance imaging in patients with postprostatectomy incontinence. Urology 68:1308
Becher E, Roehrborn CG, Siami P et al (2009) The effects of dutasteride, tamsulosin, and the combination on storage and voiding in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the Combination of Avodart and Tamsulosin study. Prostate Cancer Prostatic Dis 12:369
O’Sullivan R, Karantanis E, Stevermuer TL et al (2004) Definition of mild, moderate and severe incontinence on the 24-h pad test. BJOG 111:859
Haukoos JS, Lewis RJ (2015) The Propensity Score. JAMA 314:1637
Detry MA, Ma Y (2016) Analyzing repeated measurements using mixed models. JAMA 315:407
Weld KJ, Ames CD, Hruby G et al (2006) Evaluation of a novel knotless self-anchoring suture material for urinary tract reconstruction. Urology 67:1133
Massoud W, Thanigasalam R, El Hajj A et al (2013) Does the use of a barbed polyglyconate absorbable suture have an impact on urethral anastomosis time, urethral stenosis rates, and cost effectiveness during robot-assisted radical prostatectomy? Urology 82:90
Di Pierro GB, Baumeister P, Stucki P et al (2011) A prospective trial comparing consecutive series of open retropubic and robot-assisted laparoscopic radical prostatectomy in a centre with a limited caseload. Eur Urol 59:1
Porpiglia F, Morra I, Lucci Chiarissi M et al (2013) Randomised controlled trial comparing laparoscopic and robot-assisted radical prostatectomy. Eur Urol 63:606
Honda M, Wakita T, Onishi Y et al (2014) Development and validation of a symptom scale to evaluate postoperative patients with esophagogastric cancer. J Am Coll Surg 219:895
Honda M, Wakita T, Onishi Y et al (2015) Development and validation of a disease-specific instrument to measure diet-targeted quality of life for postoperative patients with esophagogastric cancer. Ann Surg Oncol 22:848
Drs. Nobuhiro Haga, Noriaki Kurita, Tomohiko Yanagida, Soichiro Ogawa, Michihiro Yabe, Hidenori Akaihata, Junya Hata, Yuichi Sato, Kei Ishibashi, Osamu Hasegawa, and Yoshiyuki Kojima have no conflict of interest or financial ties to disclose.
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Haga, N., Kurita, N., Yanagida, T. et al. Effects of barbed suture during robot-assisted radical prostatectomy on postoperative tissue damage and longitudinal changes in lower urinary tract outcome. Surg Endosc 32, 145–153 (2018). https://doi.org/10.1007/s00464-017-5649-z
- Robot-assisted laparoscopic radical prostatectomy
- Vesicourethral anastomosis
- Unidirectional barbed suture
- Lower urinary tract symptom