TY - JOUR
T1 - Outcomes with an alternative anastomotic technique after radical retropubic prostatectomy
T2 - 10-year experience
AU - Thiel, David D.
AU - Igel, Todd C.
AU - Brisson, Theodore E.
AU - Heckman, Michael G.
PY - 2006/7
Y1 - 2006/7
N2 - 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.
AB - 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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U2 - 10.1016/j.urology.2006.01.024
DO - 10.1016/j.urology.2006.01.024
M3 - Article
C2 - 16777196
AN - SCOPUS:33745811679
SN - 0090-4295
VL - 68
SP - 132
EP - 136
JO - Urology
JF - Urology
IS - 1
ER -