OBJECTIVE - to describe step by step an original urethra-vesical anastomosis technique (Urethral fixation) in patients who underwent retropubic radical prostatectomy (RRP) and compare the observed early urinary continence recovery rates with those reported in a control group receiving a standard anastomosis technique.
Moreover, we identified the predictors of early urinary continence recovery.
PATIENTS AND METHODS - We compared 70 patients who underwent RRP with urethral fixation technique with a contemporary control group of 51 patients who received RRP with a standard urethra-vesical anastomosis. In the study group, the urethra-vesical anastomosis was performed using 8 single stitches. Specifically, to avoid retraction and/or deviations we fixed the urethral stump laterally to the medial portion of levator ani muscle. Moreover, to maintain the normal position in the context of pelvic floor we fixed the urethra sphincter deeper to the medial dorsal rafe using a 3-0 PDS stitch at 6 o'clock before completing the incision of the urethral wall. Urinary continence recovery was evaluated 1 week, 1, 2 and 3 months after catheter removal. Patients self-reporting no urine leak were considered continent. Univariable and multivariable analyses were used to identify predictors of urinary incontinence at different follow-ups.
RESULTS - The two evaluated groups resulted comparable for all the pre-operative variables. One week after catheter removal, 32 (45.7%) patients in the study group and 10 (19.6%) in the control group were continents (p=0.01), respectively. Similarly, 1 month after catheter removal, 46 (65.7%) patients in the urethral fixation group and 16 (31.4%) declared to be continent (p=0.001), respectively. Two months after catheter removal, 59 (84.3%) patients in the study group and 21 (41.2%) in the control group were continents (p<0.001), respectively. Finally, 3-mo after catheter removal, 63 (90%) patients in the study group and 32 (62.7%) in the control ones were continents (p=0.001), respectively. The urethral fixation technique turned out to be an independent predictor of urinary continence recovery 1 week (OR 4.305; p=0.002); 1 month (OR 4.784; p<0.001); 2 months (OR 7.678; p<0.001) and 3 months (OR 5.152; p=0.001) after catheter removal.
CONCLUSIONS - The urethral fixation technique significantly improves early urinary continence recovery in comparison with standard technique. Moreover, our study confirmed that this surgical technique is able to be a independent predictors of urinary continence recovery 1-week, 1-mo, 2-mo and 3-mo after catheter removal. This article is protected by copyright. All rights reserved.
BJU international. 2016 Apr 28 [Epub ahead of print]
Vincenzo Ficarra, Alessandro Crestani, Marta Rossanese, Vito Palumbo, Mattia Calandriello, Giacomo Novara, Silvio Praturlon, Gianluca Giannarini
Department of Experimental and Clinic Medical Sciences, Urology Unit, University of Udine, Italy., Academic Medical Centre Hospital Santa Maria della Misericordia, Udine, Italy., Department of Urology, University of Catania, Italy., Department of Oncologic, Surgical and Gastrointestinal Sciences, Urologic Unit, University of Padova, Padova, Italy., Academic Medical Centre Hospital Santa Maria della Misericordia, Udine, Italy., Department of Oncologic, Surgical and Gastrointestinal Sciences, Urologic Unit, University of Padova, Padova, Italy., Academic Medical Centre Hospital Santa Maria della Misericordia, Udine, Italy., Academic Medical Centre Hospital Santa Maria della Misericordia, Udine, Italy.