Intracorporeal square-to-slip knot technique for vesicourethral anastomosis with single-layer anatomical reconstruction and anterior urethral sphincter preservation

Radical prostatectomy (RP) remains the gold standard for prostate cancer (PCa) treatment. In recent years, the number of RP procedures has increased, alongside the number of high-risk PCa (HR-PCa) patients choosing this treatment. Consequently, improving functional outcomes while maintaining oncological safety is crucial for this patient group. The rapid development of minimally invasive RP methods has yielded promising new techniques and approaches. However, vesicourethral anastomosis (VUA) continues to be one of the most sophisticated and challenging aspects of the operation. Aim: to describe and evaluate the safety and efficacy of a VUA technique using intracorporeal square-to-slip knots (IKS), single-layer anatomical reconstruction (SLAR), and anterior smooth muscle urethral sphincter preservation (AUS-P) during extraperitoneoscopic RP (ERP) in terms of urinary continence (UC). Materials and methods. This study included 36 patients with localized HR-PCa who underwent ERP in 2022 and 2023. The bladder neck preservation (BNP), puboprostatic ligaments (PPL-P), and maximal functional urethra length (MFUL-P), as well as VUA with IKS technique, SLAR and AUS-P, were performed in all cases. Results. The statistical analysis indicated the safety of the modified VUA technique. The operative time (OT), estimated blood loss (EBL), and hospital stay (HS) medians were within the expected range. Only 15% of patients experienced postoperative complications, all of which were classified as grade I according to the Clavien-Dindo classification. No VUA stenosis was observed after 12 months. 80.6% of patients achieved UC within the first 3 months after urethral catheter removal (CR). Conclusions. The ISK technique for VUA with SLAR and AUS-P appears to be a safe approach, with promising UC outcomes. Larger studies are needed to confirm the true UC benefits associated with this technique. The author declares no conflict of interest.