353 ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY (RARP)- ANASTOMOSIS TECHNIQUE WITHOUT POSTOPERATIVE URETHRAL CATHETER

INTRODUCTION AND OBJECTIVES: The urethrovesical anastomosis is one of the most challenging steps during radical prostatectomy. In this presented technique of robot-assisted radical prostatectomy using barbed sutures, a primary waterproof anastomosis can be achieved due to reduced suture slippage. Therefore the transurethral catheter can be neglected in favor of a suprapubic urinary diversion. METHODS: Between January 2011 and October 2012 RARP was performed in 571 patients. A double sheathed barbed suture was used for the urethrovesical anastomosis. To achieve a dorsal reconstruction, a primary waterproof anastomosis was established by employing a semicircular suture utilizing the van Velthoven technique with integrated “Rocco-stitch”. A leak-proof anastomosis was necessary to maintain the desired intravesical volume of more than 300 cc for a safe placement of the suprapubic catheter followed by the intraoperative removal of the transurethral catheter. RESULTS: Preoperatively 8 out of 571 patients had to be excluded from the study because of an urethral stricture needing internal urethrotomy with subsequent Foley catheter insertion. In 524 (93%) the anastomosis was already watertight intraoperatively and a suprapubic urinary diversion could be placed. 509 patients (90,4%) showed a radiologically sufficient anastomosis as early as the fifth postoperative day and spontaneous micturition was permitted. In 37 patients (6,6%) a renewed intermittent urinary diversion was briefly necessary due to urinary retention, urinary tract infection or extravasation confirmed by repeated cystogram. CONCLUSIONS: In more than 90% of the patients a primary waterproof anastomosis could be accomplished by a delicate anastomosis technique with integrated Rocco stitch using barbed sutures. Suprapubic urinary diversion makes the omission of a transurethral catheter achievable and prevents repeated Foley catheter placement in case of swelling of the anastomosis region. Particularly for the patients’ postoperative comfort and minimized catheter-related trauma for the anastomosis, a minimized duration of transurethral catheter is desirable und possible employing this technique.