Comparison Of Continuous Suture And Interrupted Suture In Vesicourethral Anastomosis For Radical Prostatectomy:Meta Analysis

Objective:to compare the clinical effect of continuous suture and interrupted suture in cystourethrostomy for radical prostatectomy.Method:Literature on Vesicourethral anastomosis(VUA)associated with radical prostatectomy was retrieved by computer from the establishment of the database until October 2018.Databases icluding Wan Fang Data,CNKI,VIP,CBM,Web of Science,Embase,Cochrane Library.According to the inclusion/exclusion criteria,the literature was selected in the way of parallel excerpts by two people,the quality of each included study was evaluated by the newcastle-ottawa Scale(NOS),data entry and Meta analysis were conducted by the Review Manager 5.3 software,and the quality of evidence was evaluated by the GRADE profiler 3.2.2 software.Result:A total of 453 literatures were retrieved and included in 12 studies for meta analysis,all of which were comparative studies on VUA anastomosis in radical prostatectomy.In the included studies,the quality of the literature was assessed by NOS,which varied from 5 to 9 stars.The continuous suture(CS)group of extravasation rate had more advantages than the interrupted suture(IS)group,OR=0.43(95% CI:0.31-0.59).Compared with the IS group,the urinary catheter could be romoved earlier in the CS group,MD =-3.18(95% CI:-3.77~-2.60).There was no significant difference between the IS group and the CS group in the overall anastomotic time.However,the subgroup analysis showed that CS was faster than IS in laparoscopic radical surgery,MD=-11.97(95%ci :-16.39~-7.55).In the sensitivity analysis,the results were reversed.CS required less time than IS,MD=-8.51(95% CI:-13.43~-3.60).There was no significant difference between the two groups in the incidence of strictures and the dry continence at 3/6/12 mo.Thestrictures OR=0.60(95%ci :0.35-1.03),the 3 mo OR=1.14(95%ci :0.87-1.49),the 6mo OR=1.13(95%ci :0.77-1.64),the 12 mo OR=1.46(95%ci :0.85-2.50).Conclusion:CS has advantages in extravasation rate,catheterization time,anastomotic time.Anastomotic stenosis and urinary control function were not significantly different.Both techniques are safe and can be used for vesicourethral anastomosis.The surgeon should choose the suture technique according to the personal experience,surgical method and patient’s characteristics.Due to the quality of the literature,more carefully designed studies of vesicourethral anastomosis technology are needed to further evaluate the differences,especially in long-term results.