Urethral anastomotic healing after radical retropubic prostatectomy: impact of positive urethral margin.

To determine the time course of urethral anastomotic healing after radical retropubic prostatectomy and its relationship to a positive margin at the anastomosis, the type of suture used, and the incidence of bladder neck contracture. In 119 consecutive patients a pericatheterogram was performed at 15.5 +/- 0.5 days postoperatively. A second pericatheterogram was obtained at 22.3 +/- 0.7 days for those anastomoses that were not healed, and a third pericatheterogram at 32.1 +/- 2.5 days for the remainder. Maxon sutures were used for 63 anastomoses, Dexon for 14, and chromic catgut for 42. Sixty-five anastomoses (55%) were healed at the first pericatheterogram and 104 (87%) by 22 days. Microscopic tumor at the apical cut end of the prostate was found in 20% of specimens; the healing period for these patients was 21.0 +/- 2.0 days compared with 21.1 +/- 0.8 days for those with a negative margin. The healing time for Maxon, Dexon, and chromic catgut was 21.6, 24.6, and 19.5 days, respectively. Of the 108 evaluable patients, in 10 (9.3%) significant bladder neck contracture developed at a mean of 15 weeks; 6 (10.7%) were associated with Maxon anastomoses, 1 with Dexon (8.3%), and 3 (7.5%) with chromic sutures. Five of 10 bladder neck contractures were in 11 patients with previous prostate surgery (45%). The presence of microscopic tumor at the urethral margin did not increase the risk of extravasation. There was no correlation between extravasation and bladder neck contracture, but less extravasation was associated with chromic sutures. Previous transurethral resection appeared to be a risk factor for the development of bladder neck contracture.