Laparoscopic "single knot-single running" suture vesico-urethral anastomosis with posterior musculofascial reconstruction

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.