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. 2021;74(4):528-534.
doi: 10.5173/ceju.2021.R1.0050. Epub 2021 Sep 18.

Mucosal coaptation technique for early urinary continence after robot-assisted radical prostatectomy: a comparative exploratory study

Santosh Kumar  1 , Praveen Kumar Soni  1 , Abhishek Chandna  1 , Kalpesh Parmar  1 , Pramod K Gupta  2
Affiliations

Mucosal coaptation technique for early urinary continence after robot-assisted radical prostatectomy: a comparative exploratory study

Santosh Kumar et al. Cent European J Urol. 2021.

Abstract

Introduction: Urinary incontinence is a troublesome complication following radical prostatectomy. Various robot-assisted radical prostatectomy (RARP). We describe our technique (Santosh-PGI) of urethral and urinary bladder mucosa coaptation for early continence following RARP.

Material and methods: We performed a prospective comparative study of patients planned for RARP between July 2018 and December 2019 at our centre. A total of 40 patients were enrolled in the study protocol. Following prostatectomy, patients were alternatively assigned into two groups. In one group, urethral and urinary bladder coaptation sutures were placed in a purse string manner using 3-0 Monocryl sutures and none in the another group. All patients underwent standard end to end vesico-urethral anastomosis as described by Van Velthoven. The urinary catheter was removed on day 10 after surgery. All patients were evaluated on day 1, 30 and 90 after catheter removal.

Results: The two groups, each with 20 patients, were comparable in terms of age, clinical staging and D'Amico risk classification. The operative time, blood loss and surgical margin positivity were comparable. Following catheter removal, 75% of patients in Group A (Mucosal coaptation) and 50% in Group B (Standard technique) were continent (p = 0.264). At 30 and 90 days, 90% and 95% in Group A and 60% and 80% in Group B reported continence respectively (p-0.078). Four patients in group B reported bothersome incontinence at 90 days follow-up.

Conclusions: Urethral and urinary bladder mucosal coaptation is a simple innovative technique for early continence following RARP.

Keywords: continence; prostate cancer; robot-assisted radical prostatectomy; urethral mucosal coaptation.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Schematic diagram showing A. Completion of prostatectomy; B. Purse-string suture application in proximal urethra and bladder neck; C. End-to-end vesico-urethral anastomosis performed using barbed double arm suture in continuous fashion; D. Tightening of purse-string sutures.
Figure 2
Figure 2
Intra-operative images showing the purse-string suturing of the urinary bladder and proximal urethra and vesico-urethral anastomosis.
See this image and copyright information in PMC

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