Prostatectomia Radical por Laparotomia estudo retrospectivo entre pontos separados e contínuos na realização da Anastomose Vesico-uretral em um único centro da rede de Saúde Pública

Abstract

Introduction: Prostate cancer is the second most common malignancy in men, and treatment options vary according to the patient's staging, clinical conditions and comorbidities of each case, ranging from follow-up without intervention to various interventional modalities. Radical prostatectomy continues to be widely used with the aim of healing, and the vesico-urethral anastomosis can be performed with separate or continuous stitches. However, there is still no consensus on the best technique. Objective: To compare the vesico-urethral anastomosis performed with separate or continuous stitches in patients undergoing radical prostatectomy by laparotomy, in terms of per and postoperative evolution. Method: This is a retrospective study in which data were collected from the medical records of 140 patients, and after analyzing the inclusion criteria, 86 patients remained. These patients were divided into two groups, according to the technique used to perform the vesico-urethral anastomosis: group 1, composed of 56 patients who underwent vesico-urethral anastomosis with separate stitches and 30 patients with continuous stitches, all operated by the same team, in a single urology center of the S.U.S. Mário Penna Association, between 2016 and 2019, with follow-up of at least 12 months. The two groups were considered homogeneous in terms of pre-operative assessment, using the Fisher and Shapiro-Wilk tests. The comparison between the two groups of patients in terms of perioperative and postoperative evolution was evaluated using Fisher's tests, generalized linear model and Shapiro-Wilk. Results: The comparison between the two groups regarding the per-operative complication rate showed no statistical difference (p>0.99), while the procedure time was, on average, 20 minutes longer in the group submitted to the procedure with continuous stitches ( p<0.01). Regarding the characteristics and postoperative findings, a length of hospital stay, use of sentinel drain and stenosis rates were unfavorable for the group of patients with continuous stitch anastomosis (p<0.01). The urinary incontinence rate evaluated at 02, 06 and 12 months did not show a statistically significant difference (p>0.05), however, when analyzing patients with urinary incontinence in relation to the number of diapers used per day, the group of patients with the technique with continuous stitches presented a diaper use rate 2.5 times higher at twelve months when compared to the group of separate stitches (p<0.01). Conclusion: Based on the results of this research, it can be affirmed that the vesico-urethral anastomosis with separate stitches presented better results compared to continuous stitches in patients undergoing radical prostatectomy by laparotomy, as they were shorter: surgical time, length of hospital stay, duration of the use of sentinel drain, rates of postoperative stenosis and the number of diapers used daily in patients with urinary incontinence twelve months after surgery.