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Vesicourethral Anastomosis: Putting It Back Together

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Robot-Assisted Radical Prostatectomy

Abstract

Robot-assisted radical prostatectomy (RARP) has progressively gained popularity amongst urologists and is now the dominant surgical approach for localized prostate cancer. Despite the advantages of the da Vinci surgical system (high 3-D definition, magnified vision, movement scaling, tremor filtration, and wristed instruments with 7-degrees of freedom the watertight vesicourethral anastomosis (VUA) remains one of the challenging aspects of this procedure, particularly in the early learning curve.

In this chapter, we describe our technique for achieving a tension-free, well-vascularized and water tight VUA, while sparing the neurovascular bundles. We discuss the utilization of the self-retaining VLOC suture, which has shown non-negligible advantages when compared to previous non-barbed available sutures, such as more reliable tissue tension, quicker VUA and improved patient’s recovery.

In order to obtain optimal functional continence outcomes we describe details such as urethral length preservation, anterior suspension to the pubic bone, hemostasis verification, bladder neck preservation and posterior rhabdosphincter reconstruction (Rocco). Finally we discuss post-operative care and special considerations such as VUA in the obese patient, catheter removal to minimize leakage and urinary retention, and management of bladder contractures.

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References

  1. Hu JC, Gu X, Lipsitz SR, Barry MJ, D’Amico AV, Weinberg AC, et al. Comparative effectiveness of minimally invasive vs open radical prostatectomy. JAMA. 2009;302(14):1557–64.

    Article  CAS  PubMed  Google Scholar 

  2. Berryhill Jr R, Jhaveri J, Yadav R, Leung R, Rao S, El-Hakim A, et al. Robotic prostatectomy: a review of outcomes compared with laparoscopic and open approaches. Urology. 2008;72(1):15–23.

    Article  PubMed  Google Scholar 

  3. Van Velthoven RF, Ahlering TE, Peltier A, Skarecky DW, Clayman RV. Technique for laparoscopic running urethrovesical anastomosis:the single knot method. Urology. 2003;61(4):699–702.

    Article  PubMed  Google Scholar 

  4. Krane LS, Bhandari M, Peabody JO, Menon M. Impact of percutaneous suprapubic tube drainage on patient discomfort after radical prostatectomy. Eur Urol. 2009;56(2):325–30.

    Article  PubMed  Google Scholar 

  5. Msezane LP, Reynolds WS, Gofrit ON, Shalhav AL, Zagaja GP, Zorn KC. Bladder neck contracture after robot-assisted laparoscopic radical prostatectomy: evaluation of incidence and risk factors and impact on urinary function. J Endourol. 2008;22(1):97–104.

    PubMed  Google Scholar 

  6. Schlomm T, Heinzer H, Steuber T, Salomon G, Engel O, Michl U, et al. Full functional-length urethral sphincter preservation during radical prostatectomy. Eur Urol. 2011;60(2):320–9.

    Article  PubMed  Google Scholar 

  7. Patel VR, Coelho RF, Palmer KJ, Rocco B. Periurethral suspension stitch during robot-assisted laparoscopic radical prostatectomy: description of the technique and continence outcomes. Eur Urol. 2009;56(3):472–8.

    Article  PubMed  Google Scholar 

  8. Stolzenburg JU, Do M, Kallidonis P, Ghulam N, Hellawell G, Haefner T, et al. Hemostasis during nerve-sparing endoscopic extraperitoneal radical prostatectomy. J Endourol. 2010;24(4):505–9.

    Article  PubMed  Google Scholar 

  9. Freire MP, Weinberg AC, Lei Y, Soukup JR, Lipsitz SR, Prasad SM, et al. Anatomic bladder neck preservation during robotic-assisted laparoscopic radical prostatectomy: description of technique and outcomes. Eur Urol. 2009;56(6):972–80.

    Article  PubMed  Google Scholar 

  10. Samavedi S, Abdul-Muhsin H, Pigilam S, Sivaraman A, Patel VR. Handling difficult anastomosis. Tips and tricks in obese patients and narrow pelvis. Indian J Urol. 2014;30(4):418–22.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Rocco F, Gadda F, Acquati P, Carmignani L, Favini P, Dell’Orto P, et al. Personal research: reconstruction of the urethral striated sphincter. Arch Ital Urol Androl. 2001;73(3):127–37.

    CAS  PubMed  Google Scholar 

  12. Avant OL, Jones JA, Beck H, Hunt C, Straub M. New method to improve treatment outcomes for radical prostatectomy. Urology. 2000;56(4):658–62.

    Article  CAS  PubMed  Google Scholar 

  13. Zorn KC. Robotic radical prostatectomy: assurance of water-tight vesicourethral anastomotic closure with the Lapra-Ty clip. J Endourol. 2008;22(5):863–5.

    Article  PubMed  Google Scholar 

  14. Murtha AP, Kaplan AL, Paglia MJ, Mills BB, Feldstein ML, Ruff GL. Evaluation of a novel technique for wound closure using a barbed suture. Plast Reconstr Surg. 2006;117(6):1769–80.

    Article  CAS  PubMed  Google Scholar 

  15. Rosen AD. Use of absorbable running barbed suture and progressive tension technique in abdominoplasty: a novel approach. Plast Reconstr Surg. 2010;125(3):1024–7.

    Article  CAS  PubMed  Google Scholar 

  16. Greenberg JA, Einarsson JI. The use of bidirectional barbed suture in laparoscopic myomectomy and total laparoscopic hysterectomy. J Minim Invasive Gynecol. 2008;15(5):621–3.

    Article  PubMed  Google Scholar 

  17. Moran ME, Marsh C, Perrotti M. Bidirectional-barbed sutured knotless running anastomosis v classic Van Velthoven suturing in a model system. J Endourol. 2007;21(10):1175–8.

    Article  PubMed  Google Scholar 

  18. Zorn KC, Widmer H, Lattouf JB, Liberman D, Bhojani N, Trinh QD, et al. Novel method of knotless vesicourethral anastomosis during robot-assisted radical prostatectomy: feasibility study and early outcomes in 30 patients using the interlocked barbed unidirectional V-LOC180 suture. Can Urol Assoc J. 2011;5(3):188–94.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Massoud W, Thanigasalam R, El Hajj A, Girard F, Theveniaud PE, Chatellier G, et al. Does the use of a barbed polyglyconate absorbable suture have an impact on urethral anastomosis time, urethral stenosis rates, and cost effectiveness during robot-assisted radical prostatectomy? Urology. 2013;82(1):90–4.

    Article  PubMed  Google Scholar 

  20. Arslan M, Tuncel A, Aslan Y, Kozacioglu Z, Gunlusoy B, Atan A. Comparison of the urethrovesical anastomoses with polyglecaprone (Monocryl(R)) and bidirectional barbed (V-Loc 180(R)) running sutures in laparoscopic radical prostatectomy. Arch Ital Urol Androl. 2014;86(2):90–4.

    Article  PubMed  Google Scholar 

  21. Zorn KC, Trinh QD, Jeldres C, Schmitges J, Widmer H, Lattouf JB, et al. Prospective randomized trial of barbed polyglyconate suture to facilitate vesico-urethral anastomosis during robot-assisted radical prostatectomy: time reduction and cost benefit. BJU Int. 2012;109(10):1526–32.

    Article  PubMed  Google Scholar 

  22. Huang AC, Kowalczyk KJ, Hevelone ND, Lipsitz SR, Yu HY, Plaster BA, et al. The impact of prostate size, median lobe, and prior benign prostatic hyperplasia intervention on robot-assisted laparoscopic prostatectomy: technique and outcomes. Eur Urol. 2011;59(4):595–603.

    Article  PubMed  Google Scholar 

  23. Hurtes X, Roupret M, Vaessen C, Pereira H, Faivre d'Arcier B, Cormier L, et al. Anterior suspension combined with posterior reconstruction during robot-assisted laparoscopic prostatectomy improves early return of urinary continence: a prospective randomized multicentre trial. BJU Int. 2012;110(6):875–83.

    Article  PubMed  Google Scholar 

  24. Noguchi M, Noda S, Nakashima O, Matsuoka K, Kojiro M. Suspension technique improves rapid recovery of urinary continence following radical retropubic prostatectomy. Kurume Med J. 2004;51(3-4):245–51.

    Google Scholar 

  25. Hamada A, Razdan S, Etafy MH, Fagin R, Razdan S. Early return of continence in patients undergoing robot-assisted laparoscopic prostatectomy using modified maximal urethral length preservation technique. J Endourol. 2014;28(8):930–8.

    Google Scholar 

  26. Stolzenburg JU, Nicolaus M, Kallidonis P, Do M, Dietel A, Hafner T, et al. Influence of bladder neck suspension stitches on early continence after radical prostatectomy: a prospective randomized study of 180 patients. Asian J Androl. 2011;13(6):806–11.

    Google Scholar 

  27. Mizutani Y, Uehara H, Fujisue Y, Takagi S, Nishida T, Inamoto T, et al. Urinary continence following laparoscopic radical prostatectomy: association with postoperative membranous urethral length measured using real-time intraoperative transrectal ultrasonography. Oncol Lett. 2012;3(1):181–4.

    Google Scholar 

  28. van Randenborgh H, Paul R, Kubler H, Breul J, Hartung R. Improved urinary continence after radical retropubic prostatectomy with preparation of a long, partially intraprostatic portion of the membraneous urethra: an analysis of 1013 consecutive cases. Prostate Cancer Prostatic Dis. 2004;7(3):253–7.

    Google Scholar 

  29. Tewari AK, Srivastava A, Mudaliar K, Tan GY, Grover S, El Douaihy Y, et al. Anatomical retro-apical technique of synchronous (posterior and anterior) urethral transection: a novel approach for ameliorating apical margin positivity during robotic radical prostatectomy. BJU Int. 2010;106(9):1364–73.

    Google Scholar 

  30. Rocco F, Carmignani L, Acquati P, Gadda F, Dell'Orto P, Rocco B, et al. Restoration of posterior aspect of rhabdosphincter shortens continence time after radical retropubic prostatectomy. J Urol. 2006;175(6):2201–6.

    Google Scholar 

  31. Coelho RF, Chauhan S, Orvieto MA, Sivaraman A, Palmer KJ, Coughlin G, et al. Influence of modified posterior reconstruction of the rhabdosphincter on early recovery of continence and anastomotic leakage rates after robot-assisted radical prostatectomy. Eur Urol. 2011;59(1):72–80.

    Google Scholar 

  32. Valero R, Schatloff O, Chauhan S, HwiiKo Y, Sivaraman A, Coelho RF, et al. Bidirectional barbed suture for bladder neck reconstruction, posterior reconstruction and vesicourethral anastomosis during robot assisted radical prostatectomy. Actas Urol Esp. 2012;36(2):69–74.

    Google Scholar 

  33. Gautam G, Rocco B, Patel VR, Zorn KC. Posterior rhabdosphincter reconstruction during robot-assisted radical prostatectomy: critical analysis of techniques and outcomes. Urology. 2010;76(3):734–41.

    Google Scholar 

  34. Kalisvaart JF, Osann KE, Finley DS, Ornstein DK. Posterior reconstruction and anterior suspension with single anastomotic suture in robot-assisted laparoscopic radical prostatectomy: a simple method to improve early return of continence. J Robot Surg. 2009;3(3):149–53.

    Google Scholar 

  35. Joshi N, de Blok W, van Muilekom E, van der Poel H. Impact of posterior musculofascial reconstruction on early continence after robot-assisted laparoscopic radical prostatectomy: results of a prospective parallel group trial. Eur Urol. 2010;58(1):84–9.

    Google Scholar 

  36. Woo JR, Shikanov S, Zorn KC, Shalhav AL, Zagaja GP. Impact of posterior rhabdosphincter reconstruction during robot-assisted radical prostatectomy: retrospective analysis of time to continence. J Endourol. 2009;23(12):1995–9.

    Google Scholar 

  37. Tewari A, Jhaveri J, Rao S, Yadav R, Bartsch G, Te A, et al. Total reconstruction of the vesico-urethral junction. BJU Int. 2008;101(7):871–7.

    Google Scholar 

  38. Menon M, Muhletaler F, Campos M, Peabody JO. Assessment of early continence after reconstruction of the periprostatic tissues in patients undergoing computer assisted (robotic) prostatectomy: results of a 2 group parallel randomized controlled trial. J Urol. 2008;180(3):1018–23.

    Google Scholar 

  39. Atug F, Kural AR, Tufek I, Srivastav S, Akpinar H. Anterior and posterior reconstruction technique and its impact on early return of continence after robot-assisted radical prostatectomy. J Endourol. 2012;26(4):381–6.

    Google Scholar 

  40. Valdivieso RF, Hueber PA, Zorn KC. Robot assisted radical prostatectomy: how I do it. Part II: surgical technique. Can J Urol. 2013;20(6):7073–8.

    Google Scholar 

  41. Lukasewycz S, Holman M, Kozlowski P, Porter CR, Odom E, Bernards C, et al. Does a perioperative belladonna and opium suppository improve postoperative pain following robotic assisted laparoscopic radical prostatectomy? Results of a single institution randomized study. Can J Urol. 2010;17(5):5377–82.

    Google Scholar 

  42. Khemees TA, Novak R, Abaza R. Risk and prevention of acute urinary retention after robotic prostatectomy. J Urol. 2013;189(4):1432–6.

    Google Scholar 

  43. Agarwal PK, Sammon J, Bhandari A, Dabaja A, Diaz M, Dusik-Fenton S, et al. Safety profile of robot-assisted radical prostatectomy: a standardized report of complications in 3317 patients. Eur Urol. 2011;59(5):684–98.

    Google Scholar 

  44. Harpster LE, Brien J. Initial results using a running vesicourethral anastomosis following open radical retropubic prostatectomy. J Urol. 2007;177(1):118–22. discussion 22.

    Google Scholar 

  45. Nadu A, Salomon L, Hoznek A, Olsson LE, Saint F, de La Taille A, et al. Early removal of the catheter after laparoscopic radical prostatectomy. J Urol. 2001;166(5):1662–4.

    Google Scholar 

  46. Jeong IG, You D, Yoon JH, Hong S, Lim JH, Hong JH, et al. Impact of tamsulosin on urinary retention following early catheter removal after robot-assisted laparoscopic radical prostatectomy: a prospective randomized controlled trial. Int J Urol. 2014;21(2):164–8.

    Google Scholar 

  47. Sukkarieh T, Harmon J, Penna F, Parra R. Incidence and management of anastomotic leakage following laparoscopic prostatectomy with implementation of a new anastomotic technique incorporating posterior bladder neck tailoring. J Robot Surg. 2007;1(3):213–5.

    Google Scholar 

  48. Tholomier C, Bienz M, Hueber PA, Trinh QD, Hakim AE, Alhathal N, et al. Oncological and functional outcomes of 722 robot-assisted radical prostatectomy (RARP) cases: the largest Canadian 5-year experience. Can Urol Assoc J. 2014;8(5–6):195–201.

    Google Scholar 

  49. Kostakopoulos A, Argiropoulos V, Protogerou V, Tekerlekis P, Melekos M. Vesicourethral anastomotic strictures after radical retropubic prostatectomy: the experience of a single institution. Urol Int. 2004;72(1):17–20.

    Google Scholar 

  50. Surya BV, Provet J, Johanson KE, Brown J. Anastomotic strictures following radical prostatectomy: risk factors and management. J Urol. 1990;143(4):755–8.

    Google Scholar 

  51. Gonzalgo ML, Pavlovich CP, Trock BJ, Link RE, Sullivan W, Su LM. Classification and trends of perioperative morbidities following laparoscopic radical prostatectomy. J Urol. 2005;174(1):135–9. discussion 9.

    Google Scholar 

  52. Rassweiler J, Sentker L, Seemann O, Hatzinger M, Rumpelt HJ. Laparoscopic radical prostatectomy with the Heilbronn technique: an analysis of the first 180 cases. J Urol. 2001;166(6):2101–8.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, Section of Urology, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada

    Côme Tholomier, Roger Valdivieso M.D. & Abdullah M. Alenizi M.D.

  2. Department of Urology–Director of Robotic Surgery, University of Montreal, Montreal, Canada

    Kevin Zorn M.D.

Authors
  1. Côme Tholomier
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  2. Roger Valdivieso M.D.
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  3. Abdullah M. Alenizi M.D.
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  4. Kevin Zorn M.D.
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Corresponding author

Correspondence to Côme Tholomier .

Editor information

Editors and Affiliations

  1. Department of Urology, Uro-surgical Prostate Cancer Program, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

    John W. Davis

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Tholomier, C., Valdivieso, R., Alenizi, A.M., Zorn, K. (2016). Vesicourethral Anastomosis: Putting It Back Together. In: Davis, J. (eds) Robot-Assisted Radical Prostatectomy. Springer, Cham. https://doi.org/10.1007/978-3-319-32641-2_13

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  • DOI: https://doi.org/10.1007/978-3-319-32641-2_13

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-32639-9

  • Online ISBN: 978-3-319-32641-2

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