title: Outcomes with an alternative anastomotic technique after radical retropubic prostatectomy: 10-year experience.
abstract: OBJECTIVE
  To review 10-year outcomes of an alternative vesicourethral anastomotic technique performed after radical retropubic prostatectomy (RRP).
  
  
  METHODS
  With institutional review board approval, 307 consecutive RRPs performed by one surgeon (mean patient age, 63.5 years; range, 35 to 77 years) from November 1994 to December 2004 with an alternative anastomosis were reviewed. Cox proportional hazard models with forward selection were used to investigate associations with outcomes and operative parameters.
  
  
  RESULTS
  Mean estimated blood loss (EBL) was 550 mL. Sixty-three patients (20.5%) required blood transfusion. Mean anastomotic time ranged from 8 to 22 minutes (median, 11 minutes). Nine patients (2.9%) required surgical drain for more than 2 days. A total of 246 patients were available for at least 1-year continence follow-up (mean, 51 months). Of these, 160 patients (65.0%) never leaked or required a pad at point of last follow-up; 25 patients (10.2%) required 1 non-insurance pad or more per day. Only 3 patients (1.2%) have had incontinence interventions (one artificial sphincter and two collagen injections). Operative parameters statistically associated with wearing 1 pad per day or more were EBL (P = 0.035) and time to continence (P <0.001). Forty-three patients (17.5%) required stricture dilation, with a mean time to intervention of 6 months (range, 1 to 33 months). No patient required incision of bladder neck contracture. The only statistically associated factors with stricture formation were increased age and increased EBL.
  
  
  CONCLUSIONS
  The alternative anastomotic technique is efficient and provides proper urethral alignment with a minimal rate of prolonged urinary extravasation. Long-term urinary continence is excellent, and stricture rates are acceptable compared with other anastomotic techniques.
authors.affiliation: Department of Urology, Mayo Clinic Jacksonville, Jacksonville, Florida 32224, USA.
authors.forename: David D
authors.initials: DD
authors.lastname: Thiel
authors.forename: Todd C
authors.initials: TC
authors.lastname: Igel
authors.forename: Theodore E
authors.initials: TE
authors.lastname: Brisson
authors.forename: Michael G
authors.initials: MG
authors.lastname: Heckman
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000209:etiology; D001743:Urinary Bladder / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods