Initial results using a running vesicourethral anastomosis following open radical retropubic prostatectomy

Purpose: We assessed the results of early catheter removal following radical prostatectomy using a continuous suture vesicourethral anastomosis. Materials and Methods: From March 2001 through December 2003, 76 patients underwent open radical prostatectomy, as performed by a single surgeon. A continuous 3-zero polyglactin suture was used for the vesicourethral anastomosis in 72 patients. Drain fluid creatinine on postoperative day 1 was used to assess anastomotic leakage. A cystogram was done before catheter removal in the initial 25 patients. Subsequently a cystogram was performed only if there was suspicion of urine leakage. Results: Early catheter removal was possible in 63 of 72 patients (88%). Catheter removal occurred a mean of 3.4 days (range 1 to 6) postoperatively in this group. Ten of the 14 men who required catheter reinsertion for urinary retention had the catheter removed before postoperative day 4. In the remaining 9 patients early catheter removal was not attempted. Catheter removal occurred a mean of 10.1 days (range 7 to 14) postoperatively in this group. Overall the urethral catheter was successfully removed on or before postoperative day 6 (range 1 to 6) in 78% of patients. There was no incidence of urinoma, pelvic abscess or bladder neck contracture at a mean followup of 31 months (range 2 to 46). Conclusions: A running vesicourethral anastomosis following open radical retropubic prostatectomy allows reliable early catheter removal by postoperative days 4 to 6 in most patients with no increase in morbidity.