Outcomes with an alternative anastomotic technique after radical retropubic prostatectomy: 10-year experience

David D. Thiel, Todd C. Igel, Theodore E. Brisson, Michael G. Heckman

Research output: Contribution to journalArticle

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Abstract

Objectives: To review 10-year outcomes of an alternative vesicourethral anastomotic technique performed after radical retropubic prostatectomy (RRP). Methods: With institutional review board approval, 307 consecutive RRPs performed by one surgeon (mean patient age, 63.5 years; range, 35 to 77 years) from November 1994 to December 2004 with an alternative anastomosis were reviewed. Cox proportional hazard models with forward selection were used to investigate associations with outcomes and operative parameters. Results: Mean estimated blood loss (EBL) was 550 mL. Sixty-three patients (20.5%) required blood transfusion. Mean anastomotic time ranged from 8 to 22 minutes (median, 11 minutes). Nine patients (2.9%) required surgical drain for more than 2 days. A total of 246 patients were available for at least 1-year continence follow-up (mean, 51 months). Of these, 160 patients (65.0%) never leaked or required a pad at point of last follow-up; 25 patients (10.2%) required 1 non-insurance pad or more per day. Only 3 patients (1.2%) have had incontinence interventions (one artificial sphincter and two collagen injections). Operative parameters statistically associated with wearing 1 pad per day or more were EBL (P = 0.035) and time to continence (P <0.001). Forty-three patients (17.5%) required stricture dilation, with a mean time to intervention of 6 months (range, 1 to 33 months). No patient required incision of bladder neck contracture. The only statistically associated factors with stricture formation were increased age and increased EBL. Conclusions: The alternative anastomotic technique is efficient and provides proper urethral alignment with a minimal rate of prolonged urinary extravasation. Long-term urinary continence is excellent, and stricture rates are acceptable compared with other anastomotic techniques.

Original languageEnglish (US)
Pages (from-to)132-136
Number of pages5
JournalUrology
Volume68
Issue number1
DOIs
StatePublished - Jul 2006

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Prostatectomy
Pathologic Constriction
Research Ethics Committees
Contracture
Proportional Hazards Models
Blood Transfusion
Dilatation
Urinary Bladder
Collagen
Injections

ASJC Scopus subject areas

  • Urology

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Outcomes with an alternative anastomotic technique after radical retropubic prostatectomy : 10-year experience. / Thiel, David D.; Igel, Todd C.; Brisson, Theodore E.; Heckman, Michael G.

In: Urology, Vol. 68, No. 1, 07.2006, p. 132-136.

Research output: Contribution to journalArticle

Thiel, David D. ; Igel, Todd C. ; Brisson, Theodore E. ; Heckman, Michael G. / Outcomes with an alternative anastomotic technique after radical retropubic prostatectomy : 10-year experience. In: Urology. 2006 ; Vol. 68, No. 1. pp. 132-136.
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abstract = "Objectives: To review 10-year outcomes of an alternative vesicourethral anastomotic technique performed after radical retropubic prostatectomy (RRP). Methods: With institutional review board approval, 307 consecutive RRPs performed by one surgeon (mean patient age, 63.5 years; range, 35 to 77 years) from November 1994 to December 2004 with an alternative anastomosis were reviewed. Cox proportional hazard models with forward selection were used to investigate associations with outcomes and operative parameters. Results: Mean estimated blood loss (EBL) was 550 mL. Sixty-three patients (20.5{\%}) required blood transfusion. Mean anastomotic time ranged from 8 to 22 minutes (median, 11 minutes). Nine patients (2.9{\%}) required surgical drain for more than 2 days. A total of 246 patients were available for at least 1-year continence follow-up (mean, 51 months). Of these, 160 patients (65.0{\%}) never leaked or required a pad at point of last follow-up; 25 patients (10.2{\%}) required 1 non-insurance pad or more per day. Only 3 patients (1.2{\%}) have had incontinence interventions (one artificial sphincter and two collagen injections). Operative parameters statistically associated with wearing 1 pad per day or more were EBL (P = 0.035) and time to continence (P <0.001). Forty-three patients (17.5{\%}) required stricture dilation, with a mean time to intervention of 6 months (range, 1 to 33 months). No patient required incision of bladder neck contracture. The only statistically associated factors with stricture formation were increased age and increased EBL. Conclusions: The alternative anastomotic technique is efficient and provides proper urethral alignment with a minimal rate of prolonged urinary extravasation. Long-term urinary continence is excellent, and stricture rates are acceptable compared with other anastomotic techniques.",
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