Interrupted versus Continuous Suturing for Vesicourethral Anastomosis During Radical Prostatectomy: A Systematic Review and Meta-analysis

Karl F. Kowalewski, Christian Tapking, Svetlana Hetjens, Felix Nickel, Philipp Mandel, Philipp Nuhn, Manuel Ritter, Judd W. Moul, Joachim W. Thüroff, Maximilian C. Kriegmair

Research output: Contribution to journalArticle

Abstract

Context: Vesicourethral anastomosis (VUA) is a crucial step during radical prostatectomy (RP). Generally, either a continuous (CS) or an interrupted suture (IS) is used. However, there is no clear evidence if one technique is superior to the other. Objective: This study aimed to provide a systematic overview and comparison between IS and CS for the VUA during RP. Evidence acquisition: The study was conducting according to the PRISMA guidelines. A systematic data base search (Pubmed, Embase, and Central) was performed. Outcomes included catheterization time, extravasation, anastomotic time, length of hospital stay, continence, and development of strictures. Evidence synthesis: A total of 2021 studies were retrieved, of which nine studies (1475 patients) were included in analysis. Results showed a shorter catheterization time (2.06 d; 95% confidence interval [CI]: 0.56–3.57; p = 0.007), anastomotic time (6.39 min; 95% CI: 3.68–9.10; p < 0.001), and a lower rate of extravasation (odds ratio [OR]: 2.36; 95% CI: 1.26–4.43; p < 0.007) in favor of CS. There were no differences between groups concerning length of hospital stay (0.40 d; 95% CI: −1.41–2.20; p = 0.670) or continence at 3 mo (OR: 1.09; 95% CI: 0.83–1.44; p = 0.540), 6 mo (OR: 1.04; 95% CI: 0.67–1.61; p = 0.870) or 12 mo (OR: 1.43; 95% CI: 0.92–2.24; p = 0.110), respectively. The incidence of urethral strictures was not different between the techniques (OR: 1.00; 95% CI: 0.42–2.40; p = 1.000). The quality of evidence according to Grading of Recommendations Assessment, Development and Evaluation tool was rated as low. Conclusions: This meta-analysis showed advantages of CS for catheterization time, anastomotic time, and rate of extravasation without compromising other parameters. Although CS seems to offer favorable results, its technical challenge in open RP and the generally low quality of data makes a clear recommendation impossible. Patient summary: Continuous and interrupted suturing are safe suture techniques for the vesicourethral anastomosis during radical prostatectomy. The choice of the suture technique should be based on surgeon's experience and technical approach. Systematic review registration: PROSPERO: CRD42017076126 Continuous and interrupted suturing are both established and safe techniques for vesicourethral anastomosis during radical prostatectomy. While continuous suturing might provide benefits in terms of short-term results, both techniques appear equal for long-term results.

Original languageEnglish (US)
JournalEuropean Urology Focus
DOIs
StateAccepted/In press - Jan 1 2018
Externally publishedYes

Keywords

  • Continuous suture
  • Interrupted suture
  • Prostate cancer
  • Prostatectomy
  • Suture techniques
  • Vesicourethral anastomosis

ASJC Scopus subject areas

  • Urology

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    Kowalewski, K. F., Tapking, C., Hetjens, S., Nickel, F., Mandel, P., Nuhn, P., Ritter, M., Moul, J. W., Thüroff, J. W., & Kriegmair, M. C. (Accepted/In press). Interrupted versus Continuous Suturing for Vesicourethral Anastomosis During Radical Prostatectomy: A Systematic Review and Meta-analysis. European Urology Focus. https://doi.org/10.1016/j.euf.2018.05.009