Step 9 Vesicourethral Reconstruction

The Hasson canula is replaced. A posterior tennis racket reconstruction may be necessary in case of associated large prostatic hyperplasia or previous transurethral resection of the prostate. The urethrovesical anastomosis is performed adopting the method originally described by Van Velthoven et al. (14). The running suture is prepared by knotting together two 3-0 Vicryl 5/8 sutures of a total length of 14 cm. The first running suture is initiated by placing a stitch outside in through the bladder neck and inside out on the urethra at the 4 o'clock position. Another needle is passed outside in through the bladder neck at the 3 o'clock position. The knot is blocked behind the bladder neck and the needle is

FIGURE 10 ■ Section of the urethra.

FIGURE 10 ■ Section of the urethra.

FIGURE 11 ■ Vesicourethral reconstruction: needle passages of the posterior anastomosis.

The creation of a preperitoneal space is standardized and represents a minimally invasive approach to the prostate.

placed on the right side of the operative field. The other running suture is initiated by placing a stitch symmetrical to the first at the 5 o'clock position. The posterior lip of the bladder is left 2 cm apart from the urethral posterior wall. The posterior anastomosis is completed with four needle passages outside in on the bladder and inside out on the urethra, from the right to the left (Fig. 11). Upon completion of these passages, each suture is gently pulled on an alternating basis to approximate the bladder neck to the urethra. A Foley catheter is then placed into the bladder. The anterior anastomosis is then performed by placing the first suture outside in on the bladder and inside out on the urethra, from the right to the left. At the 10 o'clock position, the two running sutures are knotted on the outside of the bladder. Inadvertent inclusion of the Foley catheter into the anastomotic running suture should be ruled out prior to inflation of the balloon. Leakage from the ure-throvesical anastomosis is ruled out by filling the bladder with 120 mL saline solution.

0 0

Post a comment