URETHRAL ANASTOMOTIC HEALING AFTER RADICAL RETROPUBIC PROSTATECTOMY -IMPACT OF POSITIVE URETHRAL MARGIN

Objectives. To determine the time course of urethral anastomotic heali ng after radical retropubic prostatectomy and its relationship to a po sitive margin at the anastomosis, the type of suture used, and the inc idence of bladder neck contracture. Methods. In 119 consecutive patien ts a pericatheterogram was performed at 15.5+/-0.5 days postoperativel y. A second pericatheterogram was obtained at 22.3+/-0.7 days for thos e anastomoses that were not healed, and a third pericatheterogram at 3 2.1+/-2.5 days for the remainder. Maxon sutures were used for 63 anast omoses, Dexon for 14, and chromic catgut for 42. Results. Sixty-five a nastomoses (55%) were healed at the first pericatheterogram and 104 (8 7%) by 22 days. Microscopic tumor at the apical cut end of the prostat e was found in 20% of specimens; the healing period for these patients was 21.0+/-2.0 days compared with 21.1+/-0.8 days for those with a ne gative margin. The healing time for Maxon, Dexon, and chromic catgut w as 21.6, 24.6, and 19.5 days, respectively. Of the 108 evaluable patie nts, in 10 (9.3%) significant bladder neck contracture developed at a mean of 15 weeks; 6 (10.7%) were associated with Maxon anastomoses, 1 with Dexon (8.3%), and 3 (7.5%) with chromic sutures. Five of 10 bladd er neck contractures were in 11 patients with previous prostate surger y (45%). Conclusions. The presence of microscopic tumor at the urethra l margin did not increase the risk of extravasation. There was no corr elation between extravasation and bladder neck contracture, but less e xtravasation was associated with chromic sutures. Previous transurethr al resection appeared to be a risk factor for the development of bladd er neck contracture.