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

1 Citation (Scopus)

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

Fingerprint

Prostatectomy
Meta-Analysis
Confidence Intervals
Odds Ratio
Length of Stay
Catheterization
Suture Techniques
Sutures
Urethral Stricture
PubMed
Pathologic Constriction
Databases
Guidelines
Incidence

Keywords

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

ASJC Scopus subject areas

  • Urology

Cite this

Interrupted versus Continuous Suturing for Vesicourethral Anastomosis During Radical Prostatectomy : A Systematic Review and Meta-analysis. / Kowalewski, Karl F.; Tapking, Christian; Hetjens, Svetlana; Nickel, Felix; Mandel, Philipp; Nuhn, Philipp; Ritter, Manuel; Moul, Judd W.; Thüroff, Joachim W.; Kriegmair, Maximilian C.

In: European Urology Focus, 01.01.2018.

Research output: Contribution to journalArticle

Kowalewski, Karl F. ; Tapking, Christian ; Hetjens, Svetlana ; Nickel, Felix ; Mandel, Philipp ; Nuhn, Philipp ; Ritter, Manuel ; Moul, Judd W. ; Thüroff, Joachim W. ; Kriegmair, Maximilian C. / Interrupted versus Continuous Suturing for Vesicourethral Anastomosis During Radical Prostatectomy : A Systematic Review and Meta-analysis. In: European Urology Focus. 2018.
@article{0504d17a37fc47999a6149c026de8056,
title = "Interrupted versus Continuous Suturing for Vesicourethral Anastomosis During Radical Prostatectomy: A Systematic Review and Meta-analysis",
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.",
keywords = "Continuous suture, Interrupted suture, Prostate cancer, Prostatectomy, Suture techniques, Vesicourethral anastomosis",
author = "Kowalewski, {Karl F.} and Christian Tapking and Svetlana Hetjens and Felix Nickel and Philipp Mandel and Philipp Nuhn and Manuel Ritter and Moul, {Judd W.} and Th{\"u}roff, {Joachim W.} and Kriegmair, {Maximilian C.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.euf.2018.05.009",
language = "English (US)",
journal = "European Urology Focus",
issn = "2405-4569",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Interrupted versus Continuous Suturing for Vesicourethral Anastomosis During Radical Prostatectomy

T2 - A Systematic Review and Meta-analysis

AU - Kowalewski, Karl F.

AU - Tapking, Christian

AU - Hetjens, Svetlana

AU - Nickel, Felix

AU - Mandel, Philipp

AU - Nuhn, Philipp

AU - Ritter, Manuel

AU - Moul, Judd W.

AU - Thüroff, Joachim W.

AU - Kriegmair, Maximilian C.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - Continuous suture

KW - Interrupted suture

KW - Prostate cancer

KW - Prostatectomy

KW - Suture techniques

KW - Vesicourethral anastomosis

UR - http://www.scopus.com/inward/record.url?scp=85048940521&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85048940521&partnerID=8YFLogxK

U2 - 10.1016/j.euf.2018.05.009

DO - 10.1016/j.euf.2018.05.009

M3 - Article

JO - European Urology Focus

JF - European Urology Focus

SN - 2405-4569

ER -