The Urethrovesical Anastomosis

  • Ahmed Ghazi
  • Jean V. JosephEmail author


Regardless of the approach to a radical prostatectomy, the urethrovesical anastomosis (UVA) remains one of the most critical and technically demanding. An optimal anastomotic closure involves creating a watertight, tension-free anastomosis with mucosal apposition and correct realignment of the bladder and urethra, without compromising the integrity of the external sphincter (Steiner et al., J Urol 145:512–514, 1991). Before the advent of minimal invasive laparoscopic surgery, the UVA was performed with difficulty as a result of suboptimal vision of a retracted urethral stump under the pubic symphysis, in addition to unfavorable ergonomics. This was generally accomplished by placing four to eight interrupted sutures between the bladder neck and urethra, which were subsequently tied after all sutures were positioned (Gillitzer and Thüroff, BJU Int 92:178–184, 2003).


  1. 1.
    Steiner MS, Morton RA, Walsh PC. Impact of anatomical radical prostatectomy on urinary continence. J Urol. 1991;145:512–4.CrossRefPubMedGoogle Scholar
  2. 2.
    Gillitzer R, Thüroff JW. Technical advances in radical retropubic prostatectomy techniques for avoiding complications. Part II: vesicourethral anastomosis and nerve-sparing prostatectomy. BJU Int. 2003;92:178–84.CrossRefPubMedGoogle Scholar
  3. 3.
    Schuessler WW, Schulam PG, Dayman RV, et al. Laparoscopic radical prostatectomy: initial short-term experience. Urology. 1997;50:854–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Guillonneau B, Vallencien G. Laparoscopic radical prostatectomy: initial experience and preliminary assessment after 65 operations. Prostate. 1999;39:71–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Hoznek A, Salomon L, Rabii R, et al. Vesicourethral anastomosis during laparoscopic radical prostatectomy: the running suture method. J Endourol. 2000;14:749–53.CrossRefPubMedGoogle Scholar
  6. 6.
    Van Velthoven RF, Ahlering TE, Peltier A, et al. Technique for laparoscopic running urethrovesical anastomosis:the single knot method. Urology. 2003;61:699–702.CrossRefPubMedGoogle Scholar
  7. 7.
    Zorn KC, Gofrit ON, Orvieto MA, et al. Robotic-assisted laparoscopic prostatectomy: functional and pathological outcomes with interfascial nerve preservation. Eur Urol. 2007;51:755–62. discussion 763.CrossRefPubMedGoogle Scholar
  8. 8.
    Ahlering TE, Skarecky D, Lee D, et al. Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol. 2003;170:1738–41.CrossRefPubMedGoogle Scholar
  9. 9.
    Menon M, Hemal AK, Tewari A, et al. The technique of apical dissection of the prostate and urethrovesical anastomosis in robotic radical prostatectomy. BJU Int. 2004;93:715–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Patel VP, Tully AS, Holmes R, et al. Robotic radical prostatectomy in the community setting the learning curve and beyond: initial 200 cases. J Urol. 2005;174:269–72.CrossRefPubMedGoogle Scholar
  11. 11.
    Murphy DG, Kerger M, Crowe H, et al. Operative details and oncological and functional outcome of robotic-assisted laparoscopic radical prostatectomy: 400 cases with a minimum of 12 months follow-up. Eur Urol. 2009;55:1358–67.CrossRefPubMedGoogle Scholar
  12. 12.
    Ball AJ, Bordeau KP, Davis JW, et al. Modified running vesicourethral anastomosis after robotically assisted laparoscopic radical prostatectomy: use of solitary Lapra-Ty to secure posterior approximation. Urology. 2005;66:16–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Berry AM, Korkes F, Ferreira M, et al. Robotic urethrovesical anastomosis: combining running and interrupted sutures. J Endourol. 2008;22:2127–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Zorn KC. Robotic radical prostatectomy: assurance of water-tight vesicourethral anastomotic closure with the Lapra-Ty clip. J Endourol. 2008;22:863–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Chuang MS, Chien GW, Orvieto MA, et al. Eliminating knot-tying during the vesico-urethral anastomosis in robot-assisted laparoscopic radical prostatectomy. BJU Int. 2007;99:483–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Moran ME, Marsh C, Perrotti M. Bidirectional-barbed sutured knotless running anastomosis v classic Van Velthoven suturing in a model system. J Endourol. 2007;21:1175–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Kaul S, Sammon J, Bhandari A, et al. A novel method of urethrovesical anastomosis during robot-assisted radical prostatectomy using a unidirectional barbed wound closure device: feasibility study and early outcomes in 51 patients. J Endourol. 2010;24:1789–93.CrossRefPubMedGoogle Scholar
  18. 18.
    Tewari AK, Srivastava A, Sooriakumaran P, et al. Use of a novel absorbable barbed plastic surgical suture enables a “self-cinching” technique of vesicourethral anastomosis during robot-assisted prostatectomy and improves anastomotic times. J Endourol. 2010;24:1645–50.CrossRefPubMedGoogle Scholar
  19. 19.
    Williams SB, Alemozaffar M, Lei Y. Randomized controlled trial of barbed polyglyconate versus polyglactin suture for robot-assisted laparoscopic prostatectomy anastomosis: technique and outcomes. Eur Urol. 2010;58:875–81.CrossRefPubMedGoogle Scholar
  20. 20.
    Hemal AK, Agarwal MM, Baddar P. Impact of newer unidirectional barbed suture on vesicouretheral anastomosis during robot-assisted radical prostatectomy and its comparison with polyglecaprone-25 suture: an initial experience. Int Urol Nephrol. 2012;44(1):125–32. Scholar
  21. 21.
    Rocco F, Carmignani L, Aquati P, et al. Restoration of posterior aspect of rhabdosphincter shortens continence time after radical retropubic prostatectomy. J Urol. 2006;175:2201–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Rocco B, Gregori A, Stener S, et al. Posterior reconstruction of the rhabdosphincter allows a rapid recovery of continence after transperitoneal videolaparoscopic radical prostatectomy. Eur Urol. 2007;51:996–1003.CrossRefPubMedGoogle Scholar
  23. 23.
    Tewari AK, Bigelow K, Rao S, Takenaka A, El-Tabi N, Te A, et al. 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. 2007;69:726.CrossRefPubMedGoogle Scholar
  24. 24.
    Tewari A, Jhaveri J, Rao S, et al. Total reconstruction of the vesico-urethral junction. BJU Int. 2008;101:871–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Menon M, Muhletaler F, Campos M, Peabody JO. Assessment of early continence after reconstruction of the periprostatic tissues in patients undergoing computer assisted (robotic) prostatectomy: results of a 2 group parallel randomized controlled trial. J Urol. 2008;180:1018–23.CrossRefPubMedGoogle Scholar
  26. 26.
    Sammon JD, Muhletaler F, Peabody JO, et al. Long-term functional urinary outcomes comparing single- vs double-layer urethrovesical anastomosis: two-year follow-up of a two-group parallel randomized controlled trial. Urology. 2010;76:1102–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Patel VR, Coelho RF, Palmer KJ, Rocco B. Periurethral suspension stitch during robotic assisted laparoscopic radical prostatectomy. Description of the technique and continence outcomes. Eur Urol. 2009;56:472–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of UrologyUniversity of Rochester Medical CenterRochesterUSA

Personalised recommendations