TY - JOUR
TI - Prevention of Urethral Retraction with Stay Sutures (PURS) during Robot-Assisted Radical Prostatectomy Improves Early Urinary Control: A Prospective Cohort Study
AU - Argun, O.B.
AU - Tuna, M.B.
AU - Doganca, T.
AU - Obek, C.
AU - Mourmouris, P.
AU - Tufek, I.
AU - Erdogan, S.
AU - Cetinel, B.
AU - Kural, A.R.
JO - Journal of Endourology Case Reports
PY - 2018
VL - 32
TODO - 2
SP - 125-132
PB - MARY ANN LIEBERT INC PUBL
SN - null
TODO - 10.1089/end.2017.0460
TODO - adult;  Article;  clinical outcome;  cohort analysis;  disease severity;  human;  ICIQ (incontinence);  intermethod comparison;  major clinical study;  male;  middle aged;  postoperative period;  preoperative evaluation;  priority journal;  prospective study;  prostate cancer;  quality of life;  repeat procedure;  robot-assisted prostatectomy;  surgeon;  ureteroureterostomy;  urethral catheterization;  urine incontinence;  urine retention;  aged;  anastomosis;  procedures;  prostate tumor;  prostatectomy;  reproducibility;  robotic surgical procedure;  suture technique;  urethra;  urine incontinence;  urine retention, Aged;  Anastomosis, Surgical;  Humans;  Male;  Middle Aged;  Postoperative Period;  Prospective Studies;  Prostatectomy;  Prostatic Neoplasms;  Quality of Life;  Reproducibility of Results;  Robotic Surgical Procedures;  Suture Techniques;  Urethra;  Urinary Incontinence;  Urinary Retention
TODO - Objective: To evaluate early continence rates with a novel modified vesicourethral anastomosis technique based on prevention of urethral retraction using anastomosis sutures as stay sutures (PURS) during robot-assisted radical prostatectomy. Materials and Methods: Sixty patients operated by a single surgeon were enrolled and data collected prospectively. This cohort was compared with another consecutive 60 patients operated with standard anastomosis. The new technique is based on preventing urethral retraction of the posterior urethra with two anastomosis sutures being used as stay sutures. The outcomes were prospectively followed and groups compared regarding early continence. International Consultation on Incontinence Questionnaire Short Form was used to assess incontinence and its impact on the quality of life. Pad use (yes or no pads) was evaluated as a more stringent criterion. Results: Preoperative patient characteristics were similar between the two groups. Anastomosis was completed faster in PURS group (15.1 vs 18.5 min, p = 0.05). At postoperative week 1 and month 1, the severity and bother of incontinence were significantly less in the PURS group (12.7 vs 4.1 and 10.1 vs 2.6, p < 0.001). PURS cohort reported significantly superior pad-free rates at both postoperative month 1 (73% vs 35%, p < 0.0001) and month 3 (83% vs 53%, p = 0.0004). On multivariable analysis, younger age and the new anastomosis technique were two independent predictors to improve early continence. Four patients in modified anastomosis group (4/60) and 1 in standard anastomosis group (1/60) necessitated temporary urethral recatheterization because of urinary retention. Conclusion: We describe a simple and time-efficient modified urethrovesical anastomosis technique by using anastomosis sutures as stay sutures to prevent perineal retraction of the urethral stump. Our results demonstrated that the technique is an independent factor impacting early recovery of urinary continence. Future randomized controlled studies would be required to further test the reproducibility of this technique. © Copyright 2018, Mary Ann Liebert, Inc.
ER -