title: Decreasing operative time and incontinence rates in patients treated with radical cystectomy and urethral diversion: a prospective randomized trial using a new suturing device (CAPIO).
abstract: OBJECTIVE
  Radical cystectomy and orthotopic urinary diversion has been associated with significant long surgery time and postoperative urinary incontinence. We undertook a prospective randomized study to investigate the potential decrease in surgery time and improvement in the continence rate using a new suturing device compared with the traditional suture ligation, which is used for urethro-ileal anastomosis after radical cystectomy and orthotopic diversion for invasive bladder carcinoma.
  
  
  METHODS
  Between April 2005 and March 2010, 50 consecutive patients (37 men and 13 women) were recruited for the study. They were all subjected to radical cystectomy and W ileal neobladder orthotopic diversion by two senior surgeons. They were divided and randomized into two equal groups according to the methods of urethro-ileal anastomosis. The preoperative characteristics of both groups were equally distributed. One group underwent urethro-ileal anastomosis by the CAPIO suturing device, and the other group subjected to the usual stitches by needle older. Operative and early postoperative parameters were assessed. We followed the patients for 6 months postoperatively.
  
  
  RESULTS
  The preoperative parameters of the two groups were equally distributed with no statistically significant difference in any parameter. There were no intraoperative deaths. The mean time spent for urethro-ileal anastomosis in CAPIO group was 10.2 ± 1.4 min versus 19.6 ± 2.4 min, which was statistically significant (P value = 0.0001). Also, the mean blood loss was less in the CAPIO group (P value 0.05). As regard the early postoperative follow-up, the postoperative continence rate was significantly better in the CAPIO group than in the classic suturing group.
  
  
  CONCLUSIONS
  CAPIO as a new suturing device significantly shortened the time needed to achieve the urethro-ileal anastomosis with better early postoperative continence rate. It makes urethral stump accessible at any time during surgery. It also enables surgeons to do anastomosis at any time after cystectomy with any number of sutures.
authors.affiliation: Department of Urology, Sohag Faculty of Medicine, Sohag, Egypt. drabadawy@hotmail.com
authors.forename: Abdelbasset A
authors.initials: AA
authors.lastname: Badawy
authors.forename: Mohamad Dyaa
authors.initials: MD
authors.lastname: Saleem
authors.forename: Eman Abd
authors.initials: EA
authors.lastname: El-Baset
authors.forename: Esamaldin S
authors.initials: ES
authors.lastname: Morsi
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D016063:Blood Loss, Surgical; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013536:Suture Techniques / Q000295:instrumentation*; D013997:Time Factors; D014521:Urethra / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects; D014549:Urinary Incontinence / Q000209:etiology* / Q000517:prevention & control