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  • Title: Outcomes with an alternative anastomotic technique after radical retropubic prostatectomy: 10-year experience.
    Author: Thiel DD, Igel TC, Brisson TE, Heckman MG.
    Journal: Urology; 2006 Jul; 68(1):132-6. PubMed ID: 16777196.
    Abstract:
    OBJECTIVES: To review 10-year outcomes of an alternative vesicourethral anastomotic technique performed after radical retropubic prostatectomy (RRP). METHODS: With institutional review board approval, 307 consecutive RRPs performed by one surgeon (mean patient age, 63.5 years; range, 35 to 77 years) from November 1994 to December 2004 with an alternative anastomosis were reviewed. Cox proportional hazard models with forward selection were used to investigate associations with outcomes and operative parameters. RESULTS: Mean estimated blood loss (EBL) was 550 mL. Sixty-three patients (20.5%) required blood transfusion. Mean anastomotic time ranged from 8 to 22 minutes (median, 11 minutes). Nine patients (2.9%) required surgical drain for more than 2 days. A total of 246 patients were available for at least 1-year continence follow-up (mean, 51 months). Of these, 160 patients (65.0%) never leaked or required a pad at point of last follow-up; 25 patients (10.2%) required 1 non-insurance pad or more per day. Only 3 patients (1.2%) have had incontinence interventions (one artificial sphincter and two collagen injections). Operative parameters statistically associated with wearing 1 pad per day or more were EBL (P = 0.035) and time to continence (P <0.001). Forty-three patients (17.5%) required stricture dilation, with a mean time to intervention of 6 months (range, 1 to 33 months). No patient required incision of bladder neck contracture. The only statistically associated factors with stricture formation were increased age and increased EBL. CONCLUSIONS: The alternative anastomotic technique is efficient and provides proper urethral alignment with a minimal rate of prolonged urinary extravasation. Long-term urinary continence is excellent, and stricture rates are acceptable compared with other anastomotic techniques.
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