Urethrovesical anastomosis ledderhose disease diet – prostate cancer

We use Ethicon needle drivers during the procedure and use ledderhose disease diet the two ports on either side of the umbilicus. The authors use interrupted 2-0 polyglactin sutures on a 26-mm SH needle with intracorporeal knot tying. The 17.45-mm RB1 needle can also be used (Ethicon Inc., Somerville, NJ). The first suture is placed inside out on the urethra ledderhose disease diet and outside in on the bladder with a right-hand forehand approach at the 5 o’ clock position. The second stitch is a 6 o’clock stitch, which is placed right-hand forehand inside out on the urethra and left-hand forehand outside in on the bladder and tied within ledderhose disease diet the lumen. The third stitch is a 7 o’clock stitch right-hand forehand inside out on the urethra and left-hand forehand outside in on the bladder. These sutures are tied within the lumen of the anastomosis ledderhose disease diet and have not caused problems with intra-luminal calcification. The metal sound within the urethra helps guide the needles ledderhose disease diet through the full thickness of the urethra. A perineal sponge stick is used to exert pressure in ledderhose disease diet the perineum to help visualize the urethral stump clearly. A total of 6-12 interrupted sutures are placed, depending on the size of the bladder neck and the ledderhose disease diet urethra to create a watertight anastomosis. All other sutures are placed with extraluminal knot tying. After the three posterior sutures are placed, the lateral sutures of both sides are placed: the right-hand forehand outside in on the bladder and left-hand backhand inside out on the urethra on the right ledderhose disease diet side. The left side stitches are placed left-hand forehand outside in on the bladder and right-hand backhand Fig. 37.12. Anastomosis. The urethrovesicle anastomosis is performed with interrupted 2/0 polyglactin suture. A metal urethral bougie facilitates the anastomosis.

inside out on the urethra. The anterior stitches are placed at the 1 and 11 ledderhose disease diet o’clock positions: right-hand forehand outside in on the urethra and right-hand forehand inside out on the bladder for the 1 ledderhose disease diet o’clock position. The 11 o’clock position is also similarly inserted. These last two stitches are inserted and not tied until ledderhose disease diet the Foley catheter is confirmed under visual guidance to be ledderhose disease diet within the bladder through the anastomosis. Ten milliliters of water is instilled into the balloon of ledderhose disease diet the 18F Foley catheter, and the two last stitches are tied (Fig. 37.12).

The urethrovesical anastomosis, during initial experience, is the most time-consuming and difficult part of the operation, especially for those surgeons who are not facile at intracorporeal ledderhose disease diet suturing. However, with experience, this is predictable and precise. Practice in a pelvic trainer results in considerable and significant ledderhose disease diet decrease in the operating time for this part of the ledderhose disease diet surgery. After the anastomosis is complete, the Foley catheter is irrigated to ensure that the anastomosis ledderhose disease diet is watertight.

A total of three knots are tied for each of ledderhose disease diet these sutures that are inserted, the first one being a surgeon’s knot to ensure that these sutures do not slip ledderhose disease diet and the anastomosis is secure. The suture length is about 7 inches for each interrupted ledderhose disease diet stitch. However, as experience is gained, a 9-inch stitch can be used for two or three interrupted ledderhose disease diet stitches. A self-righting needle driver must not be used for the laparoscopic ledderhose disease diet prostatectomy, since the needle would need to be adjusted to various ledderhose disease diet different angles for each of the sutures, depending on its position in the urethrovesical anastomosis. In our experience, there were four anastomotic leaks in our first eight patients, but all of these were treated conservatively with continued urethral ledderhose disease diet catheter drainage. All patients thereafter did not have an anastomotic leak.