Abstract
Objective. To investigate whether posterior and anterior fixation of the vesicourethral anastomosis during robotic radical prostatectomy (RRP) helps to establish continence earlier. Material and methods. Forty-seven consecutive patients undergoing RRP were randomized into two groups. The first group received a typical Van Velthoven vesicourethral anastomosis and the second group a modified anastomosis with posterior and anterior fixation. In this group the posterior fibrous tissues of the sphincter were sutured to the residual Denonvilliers' fascia. The anastomosis with two running sutures started at the 6 o'clock position on the bladder neck and continued upwards. Two-step stitching was done on the upper half of the anastomosis to ensure good stabilization of the bladder: a small portion of urethral stump followed by a deep haemostatic stitch on the plexus. Continence, as measured by patient self-reporting of the number of pads used per 24 h, was assessed 7 weeks after catheter removal, by telephone interview. The use of no pads or one pad was defined as "continent", two pads as "moderate incontinence" and more than two pads as "severe incontinence". Results. At catheter removal, more patients in the fixation group were continent than in the Van Velthoven group [9/23 (39%) vs 3/24 (12.5%), p 0.036]. At 7 weeks, continence was even better in the fixation group [15/23 (65%) vs 8/24 (33%), p 0. 029]. The mean pad usage was less in the fixation group (1.43 vs 2.25, p 0.032). Conclusions. The posterior and anterior fixation of the vesicourethral anastomosis during RRP results in an intact sphincteric mechanism, because no stretch is applied to the urethra, resulting in earlier continence.
| Original language | English |
|---|---|
| Pages (from-to) | 5-10 |
| Number of pages | 6 |
| Journal | Scandinavian Journal of Urology and Nephrology |
| Volume | 44 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 2010 |
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Keywords
- Anastomosis
- Continence
- DaVinci robot
- Robotic prostatectomy
- Urethral fixation
ASJC Scopus subject areas
- Nephrology
- Urology
Cite this
Posterior and anterior fixation of the urethra during robotic prostatectomy improves early continence rates. / Koliakos, Nikolaos; Mottrie, Alexandre; Buffi, Nicolo; De Naeyer, Geert; Willemsen, Pieter; Fonteyne, Etienne.
In: Scandinavian Journal of Urology and Nephrology, Vol. 44, No. 1, 2010, p. 5-10.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Posterior and anterior fixation of the urethra during robotic prostatectomy improves early continence rates
AU - Koliakos, Nikolaos
AU - Mottrie, Alexandre
AU - Buffi, Nicolo
AU - De Naeyer, Geert
AU - Willemsen, Pieter
AU - Fonteyne, Etienne
PY - 2010
Y1 - 2010
N2 - Objective. To investigate whether posterior and anterior fixation of the vesicourethral anastomosis during robotic radical prostatectomy (RRP) helps to establish continence earlier. Material and methods. Forty-seven consecutive patients undergoing RRP were randomized into two groups. The first group received a typical Van Velthoven vesicourethral anastomosis and the second group a modified anastomosis with posterior and anterior fixation. In this group the posterior fibrous tissues of the sphincter were sutured to the residual Denonvilliers' fascia. The anastomosis with two running sutures started at the 6 o'clock position on the bladder neck and continued upwards. Two-step stitching was done on the upper half of the anastomosis to ensure good stabilization of the bladder: a small portion of urethral stump followed by a deep haemostatic stitch on the plexus. Continence, as measured by patient self-reporting of the number of pads used per 24 h, was assessed 7 weeks after catheter removal, by telephone interview. The use of no pads or one pad was defined as "continent", two pads as "moderate incontinence" and more than two pads as "severe incontinence". Results. At catheter removal, more patients in the fixation group were continent than in the Van Velthoven group [9/23 (39%) vs 3/24 (12.5%), p 0.036]. At 7 weeks, continence was even better in the fixation group [15/23 (65%) vs 8/24 (33%), p 0. 029]. The mean pad usage was less in the fixation group (1.43 vs 2.25, p 0.032). Conclusions. The posterior and anterior fixation of the vesicourethral anastomosis during RRP results in an intact sphincteric mechanism, because no stretch is applied to the urethra, resulting in earlier continence.
AB - Objective. To investigate whether posterior and anterior fixation of the vesicourethral anastomosis during robotic radical prostatectomy (RRP) helps to establish continence earlier. Material and methods. Forty-seven consecutive patients undergoing RRP were randomized into two groups. The first group received a typical Van Velthoven vesicourethral anastomosis and the second group a modified anastomosis with posterior and anterior fixation. In this group the posterior fibrous tissues of the sphincter were sutured to the residual Denonvilliers' fascia. The anastomosis with two running sutures started at the 6 o'clock position on the bladder neck and continued upwards. Two-step stitching was done on the upper half of the anastomosis to ensure good stabilization of the bladder: a small portion of urethral stump followed by a deep haemostatic stitch on the plexus. Continence, as measured by patient self-reporting of the number of pads used per 24 h, was assessed 7 weeks after catheter removal, by telephone interview. The use of no pads or one pad was defined as "continent", two pads as "moderate incontinence" and more than two pads as "severe incontinence". Results. At catheter removal, more patients in the fixation group were continent than in the Van Velthoven group [9/23 (39%) vs 3/24 (12.5%), p 0.036]. At 7 weeks, continence was even better in the fixation group [15/23 (65%) vs 8/24 (33%), p 0. 029]. The mean pad usage was less in the fixation group (1.43 vs 2.25, p 0.032). Conclusions. The posterior and anterior fixation of the vesicourethral anastomosis during RRP results in an intact sphincteric mechanism, because no stretch is applied to the urethra, resulting in earlier continence.
KW - Anastomosis
KW - Continence
KW - DaVinci robot
KW - Robotic prostatectomy
KW - Urethral fixation
UR - http://www.scopus.com/inward/record.url?scp=76749168513&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=76749168513&partnerID=8YFLogxK
U2 - 10.3109/00365590903413627
DO - 10.3109/00365590903413627
M3 - Article
C2 - 19958072
AN - SCOPUS:76749168513
VL - 44
SP - 5
EP - 10
JO - Scandinavian Journal of Urology and Nephrology
JF - Scandinavian Journal of Urology and Nephrology
SN - 0036-5599
IS - 1
ER -