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Title: Assessment of the effect of vesicourethral anastomosis using single-knot running suture according to own study and van Velthoven single running suture for the effectiveness of restoration of urinary tract continuity, occurrence of postoperative complications and quality of life of patients with prostate cancer and subjected to laparoscopic radical prostatectomy

Author:

Dudek, Przemysław

Date:

2018

Type:

Praca doktorska

Abstract:

Aim The aim of this experiment was to investigate the surgical efficiency (including procedure time, drainage time and hospital stay), complications profile (including bladder neck stenosis and urinary incontinence) and patients' quality of life after the surgery as a result of a single absorbable running suture (Van Velthoven variant) versus single-knot running suture (Chlosta variant) for vesico-urethral anastomosis during laparoscopic radical prostatectomy.Materials and methods Totally, 82 consecutive patients were prospectively included in the study. The inclusion criteria applied to the study recruitment were: patient’s age ≤ 70, biopsy proven prostate cancer, organ-confined disease, PSA ≤ 20 ng/ml, pathological grade defined by the Gleason score ≤ 7, two-lobe prostate without the middle lobe.Patients were classified into two groups: I- with vesico-urethral anastomosis using the single-knot running suture technique (Chlosta variant) and II - the single running suture technique (Van Velthoven variant). The study analyzed vesico-urethral anastomosis time, operative time, drainage time, blood loss and anastomotic leak assessed by creatinine concentration in drainage output.Lower urinary tract symptoms and patients’ quality of life were investigated with IPSS and QoL questionnaires 6 months after the procedure. Urinary continence status was assessed with the pad test at 3, 6 and 12 months. Urine flow (uroflowmetry) and possible urethral strictures were evaluated at 6 and 12 months. Results The two analyzed groups were comparable in terms of descriptive statistics, clinical stage, pathological grade, preoperative prostate-specific antigen and prostate volume. There were no significant differences between groups in blood loss, drainage time and catheterization time. The total peri-operative and long-term complication rates were similar as well. The pathological T stage and Gleason scores were not statistically different between the 2 groups. However, the mean anastomosis time and the total operative time were significantly shorter for patients who underwent the single-knot running suture technique (p<0,001, p=0,02, respectively). Furthermore, the mean urine flow and the maximal urine flow were statistically higher in this group of patients (p=0,05, p=0,01, respectively). Conclusion The single-knot running suture technique is a safe method of vesico-urethral anastomosis for laparoscopic radical prostatectomy with complications profile comparable to the single running suture technique. Nonetheless, the mean anastomosis time of the single-knot running suture technique is shorter than that of the Van Velthoven technique and it leads to better urine flow observed during follow up.

Place of publishing:

Kraków

Level of degree:

2 - studia doktoranckie

Degree discipline:

urologia

Degree grantor:

Uniwersytet Jagielloński. Collegium Medicum. Wydział Lekarski.

Promoter:

Piotr Chłosta

Date issued:

2018

Identifier:

oai:dl.cm-uj.krakow.pl:4269

Call number:

ZB-129173

ControlNumberVIRTUA:

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Access rights:

tylko w bibliotece

Location of original object:

Biblioteka Medyczna Uniwersytetu Jagiellońskiego- Collegium Medicum

Subject and keywords:

prostate cancer prostatectomy vesicourethral anastomosis

Object collections:

Last modified:

May 2, 2019

In our library since:

May 2, 2019

Number of object content hits:

10

All available object's versions:

http://dl.cm-uj.krakow.pl:8080/publication/4270

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Edition name Date
ZB-129173 May 2, 2019

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