Objective : We modified the technique of anastomosis after radical retropubic prostatectomy (RRP) by replacing the single sutures by a running suture to ensure a watertight connection between the bladder and the urethra earlier, reduce the catheter time and prevent anastomotic strictures. Material and methods : A total of 140 patients have so far been treated with the new technique by the two authors only (W. Höltl and W. Tomschi). The mean follow-up time has been 26.6 months (8.1-51 months). Meticulous dissection of the membranous urethra is mandatory. The bladder neck should be spared (except after previous surgery for BPH). The two semicircumferential running sutures are tightened over the indwelling catheter. The catheter is removed on day seven provided no extravasation is detectable on cystography. Results : None of the patients showed complications except for three treated early on in the learning curve. These developed hematomas with partial disruption of the anastomosis necessitating prolonged catheterisation for up to 3 weeks. All of these 3 patients subsequently developed bladder neck strictures. In the remaining 137 patients, bladder neck strictures have so far been absent unlike in an earlier series of 359 patients where the single-suture technique had been used. Conclusions : A watertight junction between the bladder and the urethra can be achieved earlier if the anastomosis is made by a running suture. So far no bladder neck strictures have been seen except in 3 cases done in the early learning curve.
UroOncology
Volume 2, 2002 - Issue 4