Long-term Functional Urinary Outcomes Comparing Single- vs Double-layer Urethrovesical Anastomosis: Two-year Follow-up of a Two-group Parallel Randomized Controlled Trial

ObjectivesTo evaluate long-term urinary outcomes in participants of a two-group randomized clinical trial comparing continence after robotic prostatectomy (RP) between those who had reconstruction of the rhabdosphincter and puboprostatic collar (double-layer anastomosis) with those who had not.MethodsConsecutive patients (n = 116) undergoing RP at a single institution were randomized to either single- or double-layer urethrovesical (UV) anastomosis between August and December of 2007. Patients were contacted an average of 23.5 months postoperatively. A survey was performed by a third-party assessor blinded to the intervention, to evaluate urinary outcomes by International Prostate Symptom Score (IPSS), pad usage, and pad weight for those with persistent incontinence.ResultsFollow-up at 2 years was 86.5%. There was no statistically significant difference in demographic or preoperative functional variables between groups. There was no difference between groups regarding urine leakage weights, pad usage rates, long-term IPSS score, or IPSS bother score. Both patients in the cohort with incontinence and both with bladder neck contracture (requiring a single dilation) were in the single-layer UV anastomosis group (not significant), yet these patients had not experienced an anastomotic leak at one week.ConclusionsLong-term functional urinary outcomes were excellent for patients undergoing RP with either single- or double-layer UV anastomosis. IPSS scores and pad usage rates and weights were equivalent between groups. Although patients with single-layer anastomoses were more likely to have a leak at one-week cystogram and longer duration of catheter placement, this did not lead directly to bladder neck contracture or incontinence.