Modified running vesicourethral anastomosis after robotically assisted laparoscopic radical prostatectomy: use of solitary Lapra-Ty to secure posterior approximation.

OBJECTIVES: We describe a novel method of ensuring posterior approximation and preventing urinary leak during the running anastomosis of robotically assisted laparoscopic prostatectomy. METHODS: Two 3-0 Monocryl RB-1 sutures are tied end-to-end. The undyed suture is placed first at the 5-o'clock position on the bladder side outside-in and then through the urethra at the same location inside-out. Proceeding clockwise, the suture is placed twice more through both the bladder and the urethra. With gentle manipulation, the suture is cinched down to provide secure posterior approximation; however, if tension is released from the suture coming from the urethra, the approximation may loosen and could result in a potential "gap" and site for anastomotic leakage. To prevent potential loosening, tension is maintained on the stitch as a single Lapra-Ty is placed at the base of the suture as it leaves the urethra. When the tension is released, the posterior approximation is tightly maintained and the remaining anastomosis is completed. RESULTS: We have performed 110 robotically assisted laparoscopic prostatectomies. Six urinary leaks requiring prolonged catheterization were identified in our first 90 patients (6.7%). We have not experienced any urinary leakage or short-term complications in the subsequent 20 patients using this technique. CONCLUSIONS: We describe a novel technique to ensure secure posterior approximation during the vesicourethral anastomosis after robotically assisted laparoscopic prostatectomy. A single Lapra-Ty clip placed early during the anastomosis prevents potential "gaps" in the approximation that may be the source of troublesome leakage.

Transitional cell carcinoma of the bladder metastatic to the penis.

Transitional cell carcinoma of the bladder has the potential to metastasize to multiple organs, and the vascularity of the penis makes it a potential site for hematogenous metastases. We present 2 cases of transitional cell carcinoma with metastases to the penis, with a review of the published reports involving penile metastases. We also discuss the presentation of penile metastases and relevant management issues in these patients who typically have quite advanced disease at presentation.