Step 6 Urethrovesical Anastomosis

According to the authors with expertise in this technique, the preferred length of suture should equal 1.5 lengths of a laparoscopic trocar, working with two needle holders. Anastomosis is performed with interrupted 3-0 or 2-0 Vicryl on a No. 26 or UR-6 needle and all sutures are tied intracorporeally. The metal bougie with a depressed tip helps guide the needle into the urethra and the metal bougie can also help by allowing the needle to slide along the catheter. The first suture is placed at the 5 o'clock position, running inside out on the urethra (right hand, forehand). The second suture is placed at the 7 o'clock position, running inside out on the urethra (right hand, forehand) and outside in on the bladder neck (right hand, forehand). The two sutures are tied inside the urethral lumen. Then four sutures are symmetrically placed at the 4, 8, 2, and 10 o'clock positions, and tied outside the lumen similar to the Heilbronn technique.

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