1. International Neurourology Journal 2015;19:113-119
Effect of Continuous Urethro-Vesical Anastomosis Technique in Incontinence After Radical Retropubic Prostatectomy, 1:1 Matching Study
Sin Woo Lee, Deok Hyun Han, Kyu-Sung Lee, Seong Soo Jeon
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicne, Seoul, Korea
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (
org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

2. International Neurourology Journal 2015;19:113-119
PURPOSE
Vesicourethral anastomosis (VUA) is an important step in radical prostatectomy and can affect clinical course in hospital.
Few studies comparing VUA by standard interrupted and continuous suturing techniques in radical retropubic prostatectomy (RRP) have been reported.
The postoperative outcomes and continence recovery rates of patients undergoing these two variations of VUA were compared.

3. International Neurourology Journal 2015;19:113-119
MATERIALS AND MRTHODS
We conducted 1:1 propensity score matching based on age, prostate volume, pathological stage, status of nerve sparing, and two baseline characteristics (preoperative prostate-specific antigen [PSA] level and Gleason score determined by pathology) in 188 patients underwent RRP.
Patients were assigned to two groups based on the suturing method used (interrupted or continuous).
After RRP, incontinence levels were assessed at 1, 3, 6, and 12 months based on pad usage per day (0, dry; ≤1, social continence; ≥2, incontinence).

4. International Neurourology Journal 2015;19:113-119
RESULTS
The continuous VUA group had a lower incidence of VUA site leakage.
There were no significant differences in the rates of postoperative urethral stricture and pyuria between the two groups.
The rate of recovery to social continence was greater in the continuous group at postoperative 3 months.
About 50% of patients had no incontinence after 6 months in the both continuous and interrupted group. At postoperative 12 months, the dry rate 61.7% in the interrupted group and 80.4% in the continuous group.
The times required to reach social continence and no incontinence were also shorter in the continuous group, but these differences were not statistically significant.

5. International Neurourology Journal 2015;19:113-119
CONCLUSIONS
The results of this study suggest that earlier recovery to social continence and a higher rate of complete recovery (dry) could be expected with VUA by continuous suturing.
Furthermore, if adequate surgical experience is accumulated, VUA with continuous suturing could be performed without difficulty.

6. International Neurourology Journal 2015;19:113-119
Table 1. Characteristics of the two prospensity-matched groups in all patients
Characteristic
Before matched
P-value
After matched
Interrupted group (n=130)
Continuous group (n=58)
Interrupted group (n=47)
Continuous group (n=47)
Age (yr)
70.0±5.6
67.6±7.7
0.015a)
67.6±3.9
67.8±7.6
0.817a)
Preoperative PSA (ng/mL)
10.1±10.9
13.4±19.6
0.139a)
10.9±11.6
10.5±11.6
0.893a)
Prostate volume (mL)
38.4±17.8
32.9±13.2
0.036a)
32.5±19.8
33.4±13.3
0.784a)
Nerve saving
0.584b)
0.897b)
 None
88 (67.7)
36 (62.1)
31 (66.0)
29 (61.7)
 Unilateral
13 (10.0)
5 (8.6)
4 (8.5)
5 (10.6)
 Bilateral
29 (22.3)
17 (29.3)
12 (25.5)
13 (26.6)
Pathologic stage
0.561b)
0.908b)
 T2a
19 (14.7)
4 (6.9)
3 (6.4)
 T2b
1 (0.7)
0 (0) -
 T2c
59 (45.4)
27 (46.5)
22 (46.8)
23 (48.9)
 T3a
27 (20.8)
15 (25.9)
10 (21.3)
 T3b
24 (18.5)
12 (20.7)
11 (23.4)
9 (19.1)
Gleason score on pathology
0.031b)
0.972b)
 ≤6
34 (26.2)
7 (12.1)
7 (14.9)  7
73 (56.2)
33 (56.9)
27 (57.4)
26 (55.3)
 ≥8
23 (17.6)
18 (31.0)
13 (27.7)
14 (29.8)
Values are presented as mean±standard deviation or number (%).
PSA, prostate specific antigen.
a)Chi-square test. b)t-test.

7. Table 2. Postoperative outcomes
International Neurourology Journal 2015;19:
Table 2. Postoperative outcomes
Postoperative outcome
Interrupted group (n=47)
Continuous group (n=47)
P-value
Anastomosis site leakage
5 (10.6)
0 (0)
0.022a)
Urethral catheterization duration (day)
16.2±4.6 (10-35)
12.5±3.3 (7-17)
<0.001b)
Urethral stricture
3 (6.4)
1.000a)
 Anastomosis site 1
 Distal urethra 2
Postoperative pyuria
9/20 (45.0)
17/39 (43.6)
0.770a)
Pelvic abscess/lymphocele
1 (2.1)
2 (4.3)
0.557a)
 Abscess
 Lymphocele
Values are presented as number (%) or mean±standard deviation (range).
a)Chi-square test. b)t-test.

8. Table 3. Incontinence recovery rate
International Neurourology Journal 2015;19:
Table 3. Incontinence recovery rate
Variable
Interrupted group (n=47)
Continuous group (n=47)
P-value
Social continencea) rate
 Postoperative
  1 month
22/47 (46.8)
19/47 (40.4)
0.210c)
  3 months
31/47 (66.0)
40/47 (85.1)
0.031c)
  6 months
43/47 (91.5)
0.336c)
  12 months
44/47 (93.6)
43/46 (93.5)
0.978c)
 Time to social continence (mo)
3.77±3.88
3.21±3.24
0.056d)
Dryb)rate
9/47 (19.1)
7/47 (14.9)
0.583c)
18/47 (38.3)
17/47 (36.2)
0.831c)
24/47 (51.1)
28/47 (59.6)
0.407c)
29/47 (61.7)
37/46 (80.4)
0.047c)
 Time to dry (mo)
7.63±5.09
7.23±4.65
0.132d)
Values are presented as number (%) or mean±standard deviation (range).
a)Social continence (pad per day≤1). b)Dry (pad per day=0). c)Chi-square test. d)t-test.

9. International Neurourology Journal 2015;19:113-119
Fig. 1. Vesicourethral anastomosis (VUA) technique. (A) The VUA was started at the 5- to –6-o’clock position in the outside-in direction on the posterior bladder wall. (B) Then, 2–3 bites were made in the clockwise direction, and the needle could be seen passing through the urethra. Next, anticlockwise anastomosis was started from 6- to 7-o’clock position. (C) When the anastomosis was complete, the needles met at the contralateral side (urethra and bladder neck) near the 12-o’clock position, and both sutures were tied together with 8–10 knots.

10. International Neurourology Journal 2015;19:113-119
Fig. 1. Vesicourethral anastomosis (VUA) technique. (A) The VUA was started at the 5- to –6-o’clock position in the outside-in direction on the posterior bladder wall. (B) Then, 2–3 bites were made in the clockwise direction, and the needle could be seen passing through the urethra. Next, anticlockwise anastomosis was started from 6- to 7-o’clock position. (C) When the anastomosis was complete, the needles met at the contralateral side (urethra and bladder neck) near the 12-o’clock position, and both sutures were tied together with 8–10 knots.