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Adding space and colour, without tying yourself in a knot, at the bladder neck-urethral stump anastomosis during radical prostatectomy

Prostate Cancer and Prostatic Diseases volume 7, pages 268–269 (2004)Cite this article

The majority of urologists recommend radical prostatectomy as the treatment of choice for younger men with localized prostate cancer. 1 A crucial step in this procedure is the anastomosis of the reconstructed bladder neck and the urethral stump. A secure, watertight anastomosis reduces the risk of stricture formation, and increases the likelihood of a better functional result in terms of continence. We describe a technique in which the position of the sutures placed during the anastomosis is colour coded, and whereby the suture itself is positioned in the jaws of the Dunhill forceps/clip in order to reduce the chance of it twisting prior to ligation, thereby allowing a faster safer anastomosis.

Typically, during bladder neck–urethral stump anastomosis Dunhill forceps are arranged in such a way in the operative field, so that the primary surgeon can recall where in the anastomosis the sutures have been passed. This technique, however, can become problematic particularly when the clips bearing the sutures move during the procedure. This can lead to confusion and delays in forming the anastomosis, and at worse can lead to incorrect apposition of the mucosal surfaces. The advantage of the coloured clips over other methods such as the use of key-rings and metal discs3 is that the operative field remains less congested. Both these methods have an advantage in terms of time, over the use of steri-strips, which are annotated in pen and then attached to the clips.

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References

  1. Fowler Jr FJ et al. Comparison of recommendations by urologists and radiation oncologists for treatment of clinically localised prostate cancer. JAMA 2000; 283: 3258–3260.

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  2. Rowe EWJ, Hama KH, Karim OMA . Increasing safety while decreasing stress at radical prostatectomy: a novel use of the scrubbing sponge. BJU Int 2004; 94: 188–189.

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  3. Sriprasad S et al. Use of the ‘labeled key-ring clock’: a simple technique for urethral–bladder neck anastomosis. BJU Int 2003; 92: 1039–1040.

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  1. Department of Urology, Wexham Park Hospital, Slough, Berkshire, UK

    E W J Rowe, K H Attar & O M A Karim

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  1. E W J Rowe
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  2. K H Attar
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  3. O M A Karim
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Correspondence to E W J Rowe.

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Rowe, E., Attar, K. & Karim, O. Adding space and colour, without tying yourself in a knot, at the bladder neck-urethral stump anastomosis during radical prostatectomy. Prostate Cancer Prostatic Dis 7, 268–269 (2004). https://doi.org/10.1038/sj.pcan.4500729

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  • DOI: https://doi.org/10.1038/sj.pcan.4500729

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