Optimizing vesicourethral anastomosis healing after robot-assisted laparoscopic radical prostatectomy: Lessons learned from three techniques in 1900 patients

Gerald Tan, Abhishek Srivastava, Sonal Grover, David Peters, Philip Dorsey, Ann Scott, Jay Jhaveri, Derya Tilki, Alexis Te, Ashutosh Tewari

Research output: Contribution to journalArticlepeer-review

53 Scopus citations

Abstract

Background and Purpose: Creation of an optimally apposed, tension-free, well-supported vesicourethral anastomosis remains the cornerstone for anastomotic healing after radical prostatectomy. We report the effect of three techniques of bladder neck reconstruction during robot-assisted radical prostatectomy on anastomotic leak, stricture formation, and continence recovery. Patients and Methods: Between January 2005 to September 2009, 1900 consecutive patients underwent robotic-assisted laparoscopic prostatectomy (RALP) by a single surgeon. Of these, the first 214 underwent vesicourethral conventional anastomosis (CA); the next 303 men underwent anterior reconstruction (AR) only; and last 1383 men underwent total anatomic restoration (TR). Data elements included patient age, body mass index, preoperative biopsy Gleason score and prostate-specific antigen level, prostate volume, total operative time, console time, time for performing vesicourethral anastomosis, estimated blood loss, tumor stage, and margin status on final pathologic findings. Primary end points were rates of clinically significant anastomotic leaks, bladder neck contractures, and time to return of continence. Chi-square and Fisher exact tests were used for analysis of categoric variables. The Cox proportional hazard model was used for both univariate and multivariate analysis. Results: Clinically significant anastomotic leakage and bladder neck strictures were significantly fewer in the reconstructed groups (2.3% vs 1.0% vs 0.3% and 3.7% vs 1.3% vs 0.5% in the CA, AR, and TR groups, P<0.01). Continence rates at 1, 6, 12, 26, and 52 weeks after RALP were also significantly better at all time points with AR and TR compared with CA alone (P<0.001). Conclusions: TR of the continence mechanism optimizes vesicourethral anastomosis healing and hastens early continence return after RALP.

Original languageEnglish
Pages (from-to)1975-1983
Number of pages9
JournalJournal of Endourology
Volume24
Issue number12
DOIs
StatePublished - 1 Dec 2010
Externally publishedYes

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