Effect of Continuous Urethro-Vesical Anastomosis Technique in Incontinence After Radical Retropubic Prostatectomy, 1:1 Matching Study

Abstract

Purpose: Vesicourethral anastomosis (VUA) is an important step in radical prostatectomy and can affect clinical course in hospital. However, few studies comparing VUA by standard interrupted and continuous suturing techniques in radical retropubic prostatectomy (RRP) have been reported. We compared the postoperative outcomes and continence recovery rates of patients undergoing these two variations of VUA using 1:1 propensity score matching. Methods: From January 2008 to January 2014, a total of 188 patients underwent RRP. 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). 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). Results: Each group consisted of 47 patients. The continuous group had a lower incidence of VUA site leakage (0% vs. 10.6%, P=0.022), but there were no significant differences in the rates of postoperative urethral stricture (6.4% vs. 6.4%, P=1.00) and pyuria (43.6% vs. 45.0%, P=0.770) between the two groups. The rate of recovery to social continence was greater in the continuous group at postoperative 3 months (85.1% vs. 66.0%, P=0.031). About 50% of patients had no incontinence (pad per day=0) after 6 months (59.6% in the continuous group and 51.1% in the interrupted group, P=0.407) and at postoperative 12 months, the dry rate 61.7% in the interrupted group and 80.4% in the continuous group (P=0.047). The times required to reach social continence (3.21 months vs. 3.77 months, P=0.056) and no incontinence (7.23 months vs. 7.63 months, P=0.132) were also shorter in the continuous group, but these differences were not statistically significant. 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.