The risk of developing pelvic pain after radical prostatectomy is clinically significant. Multiple predisposing and perioperative factors were discussed. The aim of this study was to compare the use of two different suture materials for the anastomosis and its effect on postoperative pelvic pain and anastomotic leakage.
We prospectively randomized patients in a 1:1 ratio to a monofilament bidirectional polyglycolic-polycaprolactone suture with an anchoring system (Stratafix 4-0, Johnsen&Johnson) and RB-1 needle shape (MS) versus a braided, double armored polydioxanon suture (PDS 2-0, Johnsen&Johnson) with UR-6 needle shape (BS). All included patient underwent laparoscopic robot-assisted radical prostatectomy with continuously sutured anastomosis analogue the Van Velthoven technique. We prospectively assessed pelvic pain using the validated EPIC-26 questionnaire at 3 months postoperatively and tested for anastomotic leakage performing cystography at the sixth postoperative day.
In this preliminary analysis, 135 patients with a median age of 67 years (interquartile range [IQR] 63 – 72) were eligible for analysis; 67 in the MS group and 68 in the BS group. The median operation was 223 and 222 minutes, respectively. Thirteen and 19 patients versus 10 and 17 patients underwent extended lymph node dissection and non-never-sparing procedure among the MS and BS study groups, respectively. Of the MS and BS groups, 44 and 56 patients had locally advanced disease (T3/4, N+) in final pathology. Four patients sutured with MS and 9 patients sutured with BS suffered from pelvic pain at 3 months. Anastomotic leakage was observed in 4 and 5 patients, respectively. The use of either suture material was not associated with postoperative pelvic pain (p=0.2), nor with anastomotic leakage (p=0.7).
So far, the use of suture materials does not appear to impact postoperative pelvic pain or anastomotic leakage. To draw final conclusions, we await the results after inclusion of the preplanned 200 patients according to power analysis.