Aim: To investigate the safety, surgical efficiency and patients' ability to recover from urinary continence as a result of a single absorbable running suture versus single-knot running suture for vesicourethral anastomosis (VUA) during laparoscopic radical prostatectomy (LRP). Material and Methods: In a prospective randomised study, we evaluated 162 consecutive patients who underwent LRP with VUA using the single running suture technique or the single-knot running suture technique. Perioperative patients' characteristics, morbidity and urinary continence were analysed. Results: The baseline characteristics were similar between the 2 groups. The single running suture technique was related to decreased anastomotic and total operative times compared with the Van Velthoven technique (13.17 ± 5.74 min vs. 28.49 ± 6.45 min, p = 0.0001, and 174.41 ± 62.97 min and 184.94 ± 46.16 min, p = 0.04, respectively). Overall, urinary continence rates at 3, 6 and 12 months in groups 1 and 2 were 49.4 and 69.1%, 81.5 and 86.4%, and 91.4 and 93.8%, respectively (all with p > 0.05 except the follow-up assessment at 3 months following surgery, p = 0.011). Conclusions: Both methods ensure satisfactory rates of urinary leakage and bladder neck stricture, as well as continence after LRP. However, since the single running suture VUA technique is easier to perform, and the mean anastomosis time of the single running suture VUA technique is shorter than that of the Van Velthoven technique, it appears, therefore, preferable.

Keywords:
Vesicourethral anastomosis, Running suture, Laparoscopic radical prostatectomy
1.
Gregorio SA, Rivas JG, Molina SS, Gómez AT, Ledo JC, Sebastián JD, Barthel JJ: Laparoscopic radical prostatectomy training for residents: Hospital Universitario La Paz model. Cent European J Urol 2014;67:247-252.
2.
Gözen AS, Akin Y, Özden E, Ates M, Hruza M, Rassweiler J: Impact of body mass index on outcomes of laparoscopic radical prostatectomy with long-term follow-up. Scand J Urol 2015;49:70-76.
3.
Ozdemir AT, Altinova S, Koyuncu H, Serefoglu EC, Cimen IH, Balbay DM: The incidence of postoperative ileus in patients who underwent robotic assisted radical prostatectomy. Cent European J Urol 2014;67:19-24.
4.
Eastham JA, Kattan MW, Rogers E, Goad JR, Ohori M, Boone TB, Scardino PT: Risk factors for urinary incontinence after radical prostatectomy. J Urol 1996;156:1707-1713.
5.
Chen CC, Yang CK, Hung SW, Wang J, Ou YC: Outcome of vesicourethral anastomosis after robot-assisted laparoscopic radical prostatectomy: a 6-year experience in Taiwan. J Formos Med Assoc 2014;pii:S0929-6646(14)00002-3.
6.
Polom W, Krajka K, Fudalewski T, Matuszewski M: Treatment of urethrorectal fistulas caused by radical prostatectomy - two surgical techniques. Cent European J Urol 2014;67:93-97.
7.
Van Velthoven RF, Ahlering TE, Peltier A, Skarecky DW, Clayman RV: Technique for laparoscopic running urethrovesical anastomosis: the single knot method. Urology 2003;61:699-702.
8.
Hemal AK, Agarwal MM, Babbar P: Impact of newer unidirectional and bidirectional barbed suture on vesicourethral anastomosis during robot-assisted radical prostatectomy and its comparison with polyglecaprone-25 suture: an initial experience. Int Urol Nephrol 2012;44:125-132.
9.
Golabek T, Jarecki P, Jaskulski J, Dudek P, Szopiński T, Chłosta P: Modified technique for laparoscopic running vesicourethral anastomosis. Wideochir Inne Tech Maloinwazyjne 2014;9:357-361.
10.
Poulakis V, Skriapas K, de Vries R, Dillenburg W, Witzsch U, Becht E: Vesicourethral anastomosis during endoscopic extraperitoneal radical prostatectomy: a prospective comparison between the single-knot running and interrupted technique. Urology 2006;68:1284-1289.
11.
Simone G, Papalia R, Ferriero M, Guaglianone S, Gallucci M: Laparoscopic ‘single knot-single running' suture vesico-urethral anastomosis with posterior musculofascial reconstruction. World J Urol 2012;30:651-657.
12.
Emiliozzi P, Martini M, d'Elia G, Scarpone P, Pansadoro A, Pansadoro V: A new technique for laparoscopic vesicourethral anastomosis: preliminary report. Urology 2008;72:1341-1343.
13.
Chłosta PL, Drewa T, Jaskulski J, Dobruch J, Varkarakis J, Borówka A: Bladder neck preservation during classic laparoscopic radical prostatectomy - point of technique and preliminary results. Wideochir Inne Tech Maloinwazyjne 2012;7:89-95.
14.
Golabek T, Jaskulski J, Jarecki P, Dudek P, Szopiński T, Chłosta P: Laparoscopic radical prostatectomy with bladder neck preservation: positive surgical margin and urinary continence status. Wideochir Inne Tech Maloinwazyjne 2014;9:362-370.
15.
Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 2004;240:205-213.
16.
Shichiri Y, Kanno T, Oida T, Kanamaru H: Facilitating the technique of laparoscopic running urethrovesical anastomosis using Lapra-ty absorbable suture clips. Int J Urol 2006;13:192-194.
17.
Takeda T, Miyajima A, Kaneko G, Hasegawa M, Kikuchi E, Oya M: Unidirectional barbed suture for vesicourethral anastomosis during laparoscopic radical prostatectomy. Asian J Endosc Surg 2014;7:241-245.
18.
Miki T, Okihara K, Ukimura O, et al: Running suture for vesicourethral anastomosis in minilaparotomy radical retropubic prostatectomy. Urology 2006;67:410-412.
19.
Zarrelli G, Mastroprimiano G, Giovannone R, De Berardinis E, Gentile V, Busetto GM: Knotless ‘three-U-stitches' technique for urethrovesical anastomosis during laparoscopic radical prostatectomy. Int J Urol 2013;20:441-444.
20.
Hruby G, Marruffo F, Durak E, Collins S, Herron A, Landman J: Comparison of BioGlue reinforced and standard running sutured vesicourethral anastomoses. Urology 2006;68:1355-1359.
21.
Yang J, Shao PF, Lv Q, Song NH, Li J, Zhang W, Li P, Hua LX, Yin CJ: Continuous suture of a single absorbable suture: a new simplified vesicourethral anastomosis technique in laparoscopic radical prostatectomy. Int Surg 2014;99:656-661.
22.
Geiger-Gritsch S, Oberaigner W, Mühlberger N, Siebert U, Ladurner M, Klocker H, Horninger W: Patient-reported urinary incontinence and erectile dysfunction following radical prostatectomy: results from the European prostate centre Innsbruck. Urol Int 2015;94:419-427.
23.
De Carlo F, Celestino F, Verri C, Masedu F, Liberati E, Di Stasi SM: Retropubic, laparoscopic, and robot-assisted radical prostatectomy: surgical, oncological, and functional outcomes: a systematic review. Urol Int 2014;93:373-383.
24.
Gomez CA, Soloway MS, Civantos F, Hachiya T: Bladder neck preservation and its impact on positive surgical margins during radical prostatectomy. Urology 1993;42:689-693.
25.
Selli C, De Antoni P, Moro U, Macchiarella A, Giannarini G, Crisci A: Role of bladder neck preservation in urinary continence following radical retropubic prostatectomy. Scand J Urol Nephrol 2004;38:32-37.
26.
Tan G, Srivastava A, Grover S, Peters D, Dorsey P Jr, Scott A, Jhaveri J, Tilki D, Te A, Tewari A: Optimizing vesicourethral anastomosis healing after robot-assisted laparoscopic radical prostatectomy: lessons learned from three techniques in 1,900 patients. J Endourol 2010;24:1975-1983.
27.
Ryu J, Kwon T, Kyung YS, Hong S, You D, Jeong IG, Kim CS: Retropubic versus robot-assisted laparoscopic prostatectomy for prostate cancer: a comparative study of postoperative complications. Korean J Urol 2013;54:756-761.
28.
Thiptirapong B, Leewansangtong S, Nualyong C, Srinualnad S, Taweemonkongsap T, Chaiyaprasithi B, Amornvesukit T, Phinthusophon K, Jitpraphai S, Wattayang P, Sujijantararat P, Soontrapa S: Laparoscopic radical prostatectomy: perioperative outcomes and morbidity of 559 consecutive cases in Siriraj Hospital, Thailand. J Med Assoc Thai 2011;94:693-698.
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2015
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