title: Urethral-fixation technique improves early urinary continence recovery in patients who undergo retropubic radical prostatectomy.
abstract: OBJECTIVE
  To describe step-by-step an original urethrovesical anastomosis technique (urethral fixation) in patients undergoing retropubic radical prostatectomy (RRP), to compare their early urinary continence recovery with those in a control group receiving a standard anastomosis technique and to identify the predictors of early urinary continence recovery.
  
  
  METHODS
  We compared 70 patients who underwent RRP with the urethral-fixation technique with a contemporary control group of 51 patients who received RRP with a standard urethrovesical anastomosis. In the urethral-fixation group, the urethrovesical anastomosis was made using eight single sutures. Specifically, to avoid retraction and/or deviations, we fixed the urethral stump laterally to the medial portion of levator ani muscle. Also, to maintain the normal position in the context of the pelvic floor, we fixed the urethral sphincter deeper to the medial dorsal raphe using a 3-0 polydioxanone suture at the 6 o'clock position before completing the incision of the urethral wall. Urinary continence recovery was evaluated at 1, 4, 8 and 12 weeks after catheter removal. Patients self-reporting no urine leak were considered continent. Uni- and multivariable analyses were used to identify predictors of urinary incontinence at the different follow-up time-points.
  
  
  RESULTS
  The evaluated groups had comparable preoperative variables. At 1 week after catheter removal, 32 (45.7%) patients in the urethral-fixation group and 10 (19.6%) in the control group were continent (P = 0.01). At 4 weeks after catheter removal, 46 (65.7%) patients in the urethral-fixation group and 16 (31.4%) in the control group were continent (P = 0.001). At 8 weeks after catheter removal, 59 (84.3%) patients in the urethral-fixation group and 21 (41.2%) in the control group were continent (P < 0.001). Finally, at 12 weeks after catheter removal, 63 (90%) patients in the urethral-fixation group and 32 (62.7%) in the control group were continent (P = 0.001). The urethral-fixation technique was an independent predictor of urinary continence recovery at 1 week [odds ratio (OR) 4.305; P = 0.002); 4 weeks (OR 4.784; P < 0.001); 8 weeks (OR 7.678; P < 0.001) and 12 weeks (OR 5.152; P = 0.001) after catheter removal.
  
  
  CONCLUSIONS
  The urethral-fixation technique significantly improves early urinary continence recovery in comparison with the standard technique. Moreover, our study confirmed that this surgical technique is an independent predictor of urinary continence recovery at 1, 4, 8 and 12 weeks after catheter removal.
authors.affiliation: Urology Unit, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy.|Urology Unit, Academic Medical Centre Hospital Santa Maria della Misericordia, Udine, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.affiliation: Urology Unit, Academic Medical Centre Hospital Santa Maria della Misericordia, Udine, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Crestani
authors.affiliation: Department of Urology, University of Catania, Catania, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Rossanese
authors.affiliation: Urology Unit, Department of Oncologic, Surgical and Gastrointestinal Sciences, University of Padova, Padova, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Palumbo
authors.affiliation: Urology Unit, Academic Medical Centre Hospital Santa Maria della Misericordia, Udine, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Calandriello
authors.affiliation: Urology Unit, Department of Oncologic, Surgical and Gastrointestinal Sciences, University of Padova, Padova, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.affiliation: Urology Unit, Academic Medical Centre Hospital Santa Maria della Misericordia, Udine, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Praturlon
authors.affiliation: Urology Unit, Academic Medical Centre Hospital Santa Maria della Misericordia, Udine, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Giannarini
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D020878:Device Removal; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000601:surgery*; D020127:Recovery of Function; D013997:Time Factors; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D014549:Urinary Incontinence / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods
keywords: catheter removal; complications; prostate cancer; retropubic radical prostatectomy; urethrovesical anastomosis; urinary continence