Long-term functional urinary outcomes comparing single- vs double-layer urethrovesical anastomosis: two-year follow-up of a two-group parallel randomized controlled trial.
OBJECTIVE
To evaluate long-term urinary outcomes in participants of a two-group randomized clinical trial comparing continence after robotic prostatectomy (RP) between those who had reconstruction of the rhabdosphincter and puboprostatic collar (double-layer anastomosis) with those who had not.


METHODS
Consecutive patients (n = 116) undergoing RP at a single institution were randomized to either single- or double-layer urethrovesical (UV) anastomosis between August and December of 2007. Patients were contacted an average of 23.5 months postoperatively. A survey was performed by a third-party assessor blinded to the intervention, to evaluate urinary outcomes by International Prostate Symptom Score (IPSS), pad usage, and pad weight for those with persistent incontinence.


RESULTS
Follow-up at 2 years was 86.5%. There was no statistically significant difference in demographic or preoperative functional variables between groups. There was no difference between groups regarding urine leakage weights, pad usage rates, long-term IPSS score, or IPSS bother score. Both patients in the cohort with incontinence and both with bladder neck contracture (requiring a single dilation) were in the single-layer UV anastomosis group (not significant), yet these patients had not experienced an anastomotic leak at one week.


CONCLUSIONS
Long-term functional urinary outcomes were excellent for patients undergoing RP with either single- or double-layer UV anastomosis. IPSS scores and pad usage rates and weights were equivalent between groups. Although patients with single-layer anastomoses were more likely to have a leak at one-week cystogram and longer duration of catheter placement, this did not lead directly to bladder neck contracture or incontinence.
Sammon
Jesse D
JD
Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan 48202, USA. Jsammon1@hfhs.org
Muhletaler
Fred
F
Peabody
James O
JO
Diaz-Insua
Mireya
M
Satyanaryana
Ramgopal
R
Menon
Mani
M
D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D012371:Robotics; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology*