Use of barbed suture for continuous urethro-vesical anastomosis in open retropubic radical prostatectomy: A new and practical approach.

INTRODUCTION AND IMPORTANCE: Due to the insufficient data, further studies are required to assess the efficacy and safety of barbed sutures in open retropubic radical prostatectomy (RRP). We aimed to describe a novel vesicourethral anastomosis technique using barbed sutures during open RRP. CASE PRESENTATION: A 65-year-old male with locally advanced prostate cancer underwent open retropubic RP with lymphadenectomy. Two 30 cm 3-0 barbed sutures (V-Loc™) were tied from their loop ends for double-needle use. After placing sutures at the 6 o'clock bladder neck and urethral positions, a running suture was performed posteriorly (5 and 7 o'clock), laterally (3 and 9 o'clock), and anteriorly (1, 11, and 12 o'clock) with mucosa-to-mucosa approximation. The anastomosis was completed by tying the anterior sutures. A 16F Foley catheter was inserted, and leak testing was performed with 250 cc saline. Anastomosis was completed in 15 min. The drain was removed on postoperative day one, and the catheter on day ten. CLINICAL DISCUSSION: Barbed sutures employed for anastomosis in laparoscopic and robotic radical prostatectomies are also applicable in open surgery. This approach, particularly when utilized with the preservation of a lengthy urethra and the bladder neck, can enhance functional outcomes in open RRP. Further studies are needed. CONCLUSION: Barbed sutures offer a practical and efficient vesicourethral anastomosis in open RRP.