Laparoscopic Running Urethrovesical Anastomosis with Posterior Fixation

Introduction: Laparoscopic radical prostatectomy is a minimally invasive approach for the treatment of localized prostate cancer. The most technically demanding and time-consuming part of this procedure is the urethrovesical anastomosis. Here we describe our technique for the urethrovesical anastomosis with a posterior fixation, using a running suture with two monofilament absorbable sutures.

Technical Considerations: The first step comprises two X-shaped stitches placed in the posterior wall of the anastomosis (at 7 and 5 o'clock). Each suture is independently tied, leaving the knot (and consequently the needle) on the outside. The 7 and 5 o'clock sutures are then used to perform a clockwise (left wall) and a counterclockwise (right wall) running suture, respectively, and will meet at the 12 o'clock position for the third and final knot. An abdominal Penrose drain is routinely used for monitoring possible anastomotic leakages and is withdrawn when the 24-hour output is less than 100 mL. The patient is discharged as soon as the drain is removed. We performed this technique in 12 consecutive transperitoneal laparoscopic radical prostatectomies, with a mean anastomosis time of 37 minutes, mean operative time of 144 minutes, and mean hospital stay of 2.4 days. The average Foley catheter permanence was 9 days, and no bladder neck sclerosis/stricture was observed with a minimum follow-up of 12 months.

Conclusions: The described technique is a feasible and safe method for urethrovesical anastomosis. Although we had positive results in this initial cohort, further studies with larger series are needed to confirm these findings.