The Urethrovesical Anastomosis on Robot-Assisted Radical Prostatectomy

Regardless of the approach to a radical prostatectomy, the urethrovesical anastomosis (UVA) remains one of the most critical and technically demanding. An optimal anastomotic closure involves creating a watertight, tension-free anastomosis with mucosal apposition and correct realignment of the bladder and urethra, without compromising the integrity of the external sphincter (Steiner et al., J Urol 145:512–514, 1991). Before the advent of minimal invasive laparoscopic surgery, the UVA was performed with difficulty as a result of suboptimal vision of a retracted urethral stump under the pubic symphysis, in addition to unfavorable ergonomics. This was generally accomplished by placing four to eight interrupted sutures between the bladder neck and urethra, which were subsequently tied after all sutures were positioned (Gillitzer and Thüroff, BJU Int 92:178–184, 2003).