Vesicourethral anastomosis (VUA) is a crucial step during radical prostatectomy (RP). Generally, either a continuous (CS) or an interrupted suture (IS) is used. However, there is no clear evidence if one technique is superior to the other.
This study aimed to provide a systematic overview and comparison between IS and CS for the VUA during RP.
The study was conducting according to the PRISMA guidelines. A systematic data base search (Pubmed, Embase, and Central) was performed. Outcomes included catheterization time, extravasation, anastomotic time, length of hospital stay, continence, and development of strictures.
A total of 2021 studies were retrieved, of which nine studies (1475 patients) were included in analysis. Results showed a shorter catheterization time (2.06 d; 95% confidence interval [CI]: 0.56-3.57; p=0.007), anastomotic time (6.39min; 95% CI: 3.68-9.10; p<0.001), and a lower rate of extravasation (odds ratio [OR]: 2.36; 95% CI: 1.26-4.43; p<0.007) in favor of CS. There were no differences between groups concerning length of hospital stay (0.40 d; 95% CI: -1.41-2.20; p=0.670) or continence at 3 mo (OR: 1.09; 95% CI: 0.83-1.44; p=0.540), 6 mo (OR: 1.04; 95% CI: 0.67-1.61; p=0.870) or 12 mo (OR: 1.43; 95% CI: 0.92-2.24; p=0.110), respectively. The incidence of urethral strictures was not different between the techniques (OR: 1.00; 95% CI: 0.42-2.40; p=1.000). The quality of evidence according to Grading of Recommendations Assessment, Development and Evaluation tool was rated as low.
This meta-analysis showed advantages of CS for catheterization time, anastomotic time, and rate of extravasation without compromising other parameters. Although CS seems to offer favorable results, its technical challenge in open RP and the generally low quality of data makes a clear recommendation impossible.
Continuous and interrupted suturing are safe suture techniques for the vesicourethral anastomosis during radical prostatectomy. The choice of the suture technique should be based on surgeon's experience and technical approach.
PROSPERO: CRD42017076126.
European urology focus. 2018 Jun 12 [Epub ahead of print]
Karl F Kowalewski, Christian Tapking, Svetlana Hetjens, Felix Nickel, Philipp Mandel, Philipp Nuhn, Manuel Ritter, Judd W Moul, Joachim W Thüroff, Maximilian C Kriegmair
Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany., Department Medical Faculty Mannheim, Department of Medical Statistics, University of Heidelberg, Mannheim, Germany., Department of Urology, University of Frankfurt, Frankfurt am Main, Germany., Department of Urology, University Medical Center Mannheim, Mannheim, Germany., Division of Urologic Surgery, Duke University, Durham, North Carolina, USA., Department of Urology, University Medical Center Mannheim, Mannheim, Germany. Electronic address: .