Abstract:
BACKGROUND AND PURPOSE:Creation of an optimally apposed, tension-free, well-supported vesicourethral anastomosis remains the cornerstone for anastomotic healing after radical prostatectomy. We report the effect of three techniques of bladder neck reconstruction during robot-assisted radical prostatectomy on anastomotic leak, stricture formation, and continence recovery. PATIENTS AND METHODS:Between January 2005 to September 2009, 1900 consecutive patients underwent robotic-assisted laparoscopic prostatectomy (RALP) by a single surgeon. Of these, the first 214 underwent vesicourethral conventional anastomosis (CA); the next 303 men underwent anterior reconstruction (AR) only; and last 1383 men underwent total anatomic restoration (TR). Data elements included patient age, body mass index, preoperative biopsy Gleason score and prostate-specific antigen level, prostate volume, total operative time, console time, time for performing vesicourethral anastomosis, estimated blood loss, tumor stage, and margin status on final pathologic findings. Primary end points were rates of clinically significant anastomotic leaks, bladder neck contractures, and time to return of continence. Chi-square and Fisher exact tests were used for analysis of categoric variables. The Cox proportional hazard model was used for both univariate and multivariate analysis. RESULTS:Clinically significant anastomotic leakage and bladder neck strictures were significantly fewer in the reconstructed groups (2.3% vs 1.0% vs 0.3% and 3.7% vs 1.3% vs 0.5% in the CA, AR, and TR groups, P < 0.01). Continence rates at 1, 6, 12, 26, and 52 weeks after RALP were also significantly better at all time points with AR and TR compared with CA alone (P < 0.001). CONCLUSIONS:TR of the continence mechanism optimizes vesicourethral anastomosis healing and hastens early continence return after RALP.
journal_name
J Endouroljournal_title
Journal of endourologyauthors
Tan G,Srivastava A,Grover S,Peters D,Dorsey P Jr,Scott A,Jhaveri J,Tilki D,Te A,Tewari Adoi
10.1089/end.2009.0630subject
Has Abstractpub_date
2010-12-01 00:00:00pages
1975-83issue
12eissn
0892-7790issn
1557-900Xjournal_volume
24pub_type
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journal_title:Journal of endourology
pub_type: 杂志文章
doi:10.1089/089277903765444302
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journal_title:Journal of endourology
pub_type: 杂志文章,评审
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journal_title:Journal of endourology
pub_type: 临床试验,杂志文章
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journal_title:Journal of endourology
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pub_type: 杂志文章
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pub_type: 杂志文章
doi:10.1089/end.2010.0722
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journal_title:Journal of endourology
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journal_title:Journal of endourology
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pub_type: 杂志文章,多中心研究
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pub_type: 临床试验,杂志文章,随机对照试验
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