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SIU 2017

SIU 2017: Maximal Preservation of Intra-Pelvic Urethra Using Suture-Less Technique to Improve Early Continence after Radical Prostatectomy: 15 Years Experience

Lisbon, Portugal (UroToday.com) Urinary continence after radical prostatectomy is an important quality of life indicator. As men, particularly younger men, undergo radical treatment for cancer, urinary continence is just as important for most as cancer control. As such, many attempts have been made to help improve continence outcomes. While 4-8 interrupted sutures is the standard for an open radical prostatectomy, robotic surgery has integrated a running suture. Other modifications have been attempted without any significant improvement in continence outcomes. Maximizing urethral length has been an oft cited predictor of improved urinary continence.

In this single-institution single-surgeon series from Iran, the authors report a novel suture-less technique with very good urinary continence outcomes. Essentially, either open or laparoscopically, the single surgeon affixed the bladder neck to the periureteral tissue (3-0 suture at 12 or 9 o’clock) without completing any urethrovesicle anastamotic sutures. Following that, patients were placed on light traction to oppose bladder neck to urethra.

They had a series of 802 patients, 602 of whom had 6 months follow-up data. Median follow-up was 5 years. Average operative time was 80 minutes (open) and 260 minutes (laparoscopic).

In terms of outcomes, 94.1% and 96.1% were completely continent at 3 months and 1 year, respectively. However, they did have slightly higher rates of contracture/stricture – 16% had at least one dilation, though none needed DVIU or urethroplasty. Patients with positive surgical margins had a higher rate of incontinence (92.8% vs. 99%). Radiation therapy and higher stage of disease was associated with worse continence.

Ultimately, the continence numbers, while high are not much more than some series of standard anastomosis. Understandably, adoption of this technique may make some uncomfortable – but it is reassuring to know patients do well even without completely the anastomosis, with some traction. The higher stricture rate is a little disconcerting – and the authors fail to provide a hypothesis as to why.

While an interesting endeavor, it didn’t necessarily save much time, nor it did provide significantly higher benefit without cost.

Speaker(s): Nasser Simforoosh, Iran

Institution(s): Shahid Beheshti University of Medical Sciences, Tehran, Iran

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, twitter: @tchandra_uromd, at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal