• Karl F Kowalewski, Christian Tapking, Svetlana Hetjens, Felix Nickel, Philipp Mandel, Philipp Nuhn, Manuel Ritter, Judd W Moul, Joachim W Thüroff, and Maximilian C Kriegmair.
• Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
• Eur Urol Focus. 2019 Nov 1; 5 (6): 980-991.

ContextVesicourethral 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.ObjectiveThis study aimed to provide a systematic overview and comparison between IS and CS for the VUA during RP.Evidence AcquisitionThe 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 SynthesisA 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 (6.39min; 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.ConclusionsThis 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 SummaryContinuous 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 RegistrationPROSPERO: CRD42017076126.Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.

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