Does the Suturing Technique (Barbed Continuous versus Conventional Interrupted) Have an Impact on the Outcome of Anastomotic Urethroplasty?

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Yunus Çolakoğlu, Deniz Noyan Özlü, Ali Ayten, Metin Savun, Abdulmüttalip Şimşek This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4790632/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Oct, 2024 Read the published version in International Urology and Nephrology → Version 1 posted You are reading this latest preprint version Abstract Purpose To evaluate and compare continuous suture (CS) and interrupted suture (IS) techniques applied in excision and primary anastomosis (EPA) urethroplasty in terms of surgical success and complication rates. Methods A retrospective evaluation was conducted on patients with bulbar urethral strictures measuring ≤ 2.5 cm, who underwent EPA between April 2020 and December 2022. Patients with a history of urethral reconstruction, multiple strictures, a history of pelvic radiotherapy, a diagnosis of Lichen sclerosis, a history of surgery due to congenital penile curvature or Peyronie’s disease, and a follow-up period of less than 12 months were excluded. The patients were divided into two groups according to the suture technique used (CS or IS), and the groups were compared for demographic and perioperative data. Results A total of 97 patients (CS: n = 52, IS: n = 55) were included in the sample. The mean age of the entire patient group was calculated to be 56.2 years, and the mean stricture length was 19.3 mm. Operation time and postoperative catheter time were shorter in the CS group (94.7 ± 7.3 vs. 117.2 ± 5.7 min and 9.9 ± 1.6 vs. 15.8 ± 1.9 min, p = 0.000, respectively). The groups were similar regarding anatomical success, stress urinary incontinence, penile numbness, curvature, and postoperative infection (p > 0.0). Conclusion No significant difference was observed between the CS and IS techniques employed during EPA urethroplasty in terms of success or complications. However, in addition to reducing the operation time, the CS technique offers the advantage of safely removing the urethral catheter earlier. urethral stricture anastomotic urethroplasty continuous suture interrupted suture suture techniques Figures Figure 1 Figure 2 Introduction Urethral stricture is a frequently recurrent disease that progresses with fibrosis of the urethral mucosa and spongiosa tissue, significantly reducing the quality of life of patients [ 1 ]. Although the true incidence of the disease remains uncertain, Medicare data from the USA showed an annual incidence of 0.9% [ 2 ]. Approximately 50% of urethral strictures occur in the bulbar urethra, 30% in the penile urethra, and the remainder in a combination of the two [ 3 ]. Excision and primary anastomosis (EPA) urethroplasty is considered the gold standard treatment, with a success rate of over 90% for strictures smaller than 2 cm, which constitute the majority of cases [ 4 , 5 ]. Although absorbable sutures are mostly utilized in urethroplasty, there are major variations among surgeons concerning their preference for the continuous suture (CS) or interrupted suture (IS) technique. In this study, we aimed to evaluate and compare CS and IS techniques applied in EPA urethroplasty in terms of surgical success and complication rates. Material and Method Following the approval of the Ethics Committee of Basaksehir Cam and Sakura City Hospital (decision number: 2024.02.131), patients who underwent EPA between April 2020 and December 2022 were evaluated retrospectively. Male patients aged 18 to 75 who underwent primary urethroplasty were included in the study. The stricture length to be used as an indication of anastomotic urethroplasty remains controversial. A previous study found no significant difference in success between strictures shorter than and longer than 2 cm [ 5 ]. Patients with ≤ 2.5 cm bulbar urethral strictures were included in our study. Excluded from the study were patients who had previously undergone urethral reconstruction, those with multiple strictures, and those with a history of pelvic radiotherapy, but not those who had received endoscopic urethral stricture treatment. Additionally, patients diagnosed with Lichen sclerosus, those with a previous history of surgery due to congenital penile curvature or Peyronie’s disease, and those with a follow-up period of less than 12 months were excluded. Before surgery, urea, creatinine, complete urinalysis, urine culture, coagulation, uroflowmetry, urinary system ultrasonography, clinical history, antegrade and/or retrograde urethrography (RGU), and flexible urethrocystoscopy (for determination of the length and location of urethral stricture) examinations were performed on all patients. The patients’ age, body mass index (BMI), number of preoperative direct vision internal urethrotomy (DVIUs) performed, stricture length, preoperative and postoperative maximum flow rates on uroflowmetry (Q max ), operation times, preoperative and postoperative International Index of Erectile Function-5 (IIEF-5) scores, anatomical success rates, and postoperative stress urinary incontinence (SUI), penile numbness, penile curvature, and infectious complications were compared. Preoperative urine culture sterility was required for all patients. Patients with growth in culture were treated with appropriate antibiotics. All patients were administered broad-spectrum intravenous antibiotics (e.g., 2 g of ceftriaxone) before surgery. The patients were divided into two groups according to the suture technique used during EPA: Continue suture group: CS, and Interrupted Suture group: IS. The groups were compared for demographic and perioperative data. Surgical technique Urethroplasty procedures were performed by two experienced (> 100 cases/year) surgeons (AŞ, YÇ). The patients were placed in the exhausted lithotomy position under general anesthesia. A vertical incision was made in the perineum, and a ring retractor (Turner Warwick ring retractor) was placed after the incision of Colles’ fascia. The bulbocavenous muscle was separated from the midline to access the bulbar urethra. A cystoscopy was used to identify the distal end of the stricture, and a suspension suture was placed under the guidance of the cystoscopy image. Then, the urethra was circumferentially mobilized from the corpus cavernosum, and the stenosis area was transected and excised. In the CS group, after spatulation of the urethral ends, two segments of 3/0 V-Loc suture (Covidien Healthcare, Mansfield, MA, USA), joined together, were used for end-to-end urethral anastomosis, starting from the 12 o’clock position, covering the epithelium and spongiosum, and knitting in the opposite direction toward the 6 o’clock position (Fig. 1 ). In the IS group, the anastomosis was sutured individually using 5–6 3/0 Vicryl (Ethicon, Inc., Somerville, NJ, USA) by including the epithelium and spongiosum (Fig. 2 ). After anastomosis, an 18-Fr Foley catheter was placed in the bladder. Following the completion of the anastomosis in both groups, the urethra was fixed to the surrounding tissue. The bulbospongiosus muscle was closed over the urethra. A drain was not placed routinely. The urethral catheters were removed in the first week after discharge for the patients in the CS group and in the second week after discharge for those in the IS group. Pericatheter RGU was performed on all patients before catheter removal, and the absence of extravasation was confirmed. Subsequently, all patients were followed up with control cystoscopies at the third and 12th months. The anatomical success of the surgery was defined as being able to easily advance a 16-Fr flexible cystoscope into the bladder at the 12th month [ 6 ]. Statistical analysis Mean, standard deviation, median, minimum, maximum, frequency, and ratio values were used as the descriptive statistics of the data. The distribution of variables was measured using the Kolmogorov-Smirnov and Shapiro-Wilk tests. The independent-samples t-test and the Mann-Whitney U test were used for the analysis of quantitative independent data. The paired-samples t-test and the Wilcoxon test were conducted to analyze dependent quantitative data. The chi-square test was used in the analysis of qualitative independent data, and the Fischer test was used when the chi-square test conditions were not met. SPSS v. 27.0 was used for statistical analyses. Results The study included a total of 97 patients: 52 (53.6%) in the CS group and 55 (46.4%) in the IS group. The mean age of the patients was calculated to be 56.2 years. In the entire patient group, the mean stenosis length was 19.3 mm, the mean number of preoperative DVIUs was 2.4, and the rate of preoperative suprapubic catheterization was 24.3%. The demographic and perioperative data of the patients are given in Table 1 . Table 1 Demographic and perioperative data of the entire patient group BMI: Body mass index, IIEF-5: International Index of Erectile Function-5, UTI: Urinary tract infection, SUI: Stress urinary incontinence Mean ± SD / n (%) Age (years) 56.2 ± 11.2 BMI (kg/m 2 ) 24.8 ± 3.5 Stricture length (mm) 19.3 ± 3.3 Q max Preoperative Postoperative 5.4 ± 1.5 22.0 ± 5.2 Preoperative number of urethrotomies 2.4 ± 1.4 Preoperative suprapubic catheterization 26 (24.3) IIEF-5 score Preoperative Postoperative Change 19.3 ± 4.3 20.3 ± 4.1 1.0 ± 2.4 Postoperative data Operation time (min) 106.3 ± 13.1 Length of hospital stay (day) 2.3 ± 0.8 Postoperative catheter time (day) 12.9 ± 3.5 Postoperative infection (UTI, orchitis, and epididymitis) 7 (6.5) Penile numbness 3 (2.8) Penile curvature 2 (1.9) SUI 2 (1.9) Recurrent stricture 10 (9.3) First-year success (passing a 16-F cystoscope without difficulty) 99 (92.5) Table 2 presents the comparative analysis of the CS and IS groups. The two groups were similar in terms of age, BMI, stricture length, number of preoperative DVIUs, and the presence of suprapubic catheterization (p > 0.05). Although there was a borderline statistical non-significance in the comparison of the preoperative IIEF-5 scores of the CS and IS groups (18.7 ± 4.4 vs. 20.1 ± 4.1, p = 0.055), postoperative changes in these scores were statistically similar (1.0 ± 2.3 vs. 0.8 ± 2.4, p = 0.284). Table 2 Comparative analysis of preoperative and postoperative data between the suture groups BMI: Body mass index, IIEF-5: International Index of Erectile Function-5, UTI: Urinary tract infection, SUI: Stress urinary incontinence Mean ± SD / n (%) Continuous suture group Interrupted suture group p Age (year) 55.6 ± 11.4 56.7 ± 11.2 0.617 t BMI (kg/m 2 ) 25.3 ± 3.6 24.4 ± 3.3 0.235 m Stricture length (mm) 19.5 ± 3.5 19.1 ± 3.0 0.572 m Q max Preoperative Postoperative 5.6 ± 1.6 22.1 ± 5.5 5.2 ± 1.4 22.0 ± 4.9 0.238 m 0.881 t Preoperative number of DVIUs 2.5 ± 1.4 2.2 ± 1.3 0.314 m Preoperative suprapubic catheterization 14 (26.9) 12 (21.8) 0.538 X2 IIEF-5 Preoperative Postoperative Change Intragroup change p 18.7 ± 4.4 19.7 ± 4.5 1.0 ± 2.3 0.001 W 20.1 ± 4.1 20.9 ± 3.7 0.8 ± 2.4 0.038 W 0.055 m 0.197 m 0.284 m Postoperative data Operation time (min) 94.7 ± 7.3 117.2 ± 5.7 0.000 m Length of hospital stay (day) 2.3 ± 0.9 2.3 ± 0.7 0.680 m Postoperative catheter time (day) 9.9 ± 1.6 15.8 ± 1.9 0.000 m Postoperative infection (UTI, orchitis, and epididymitis) 4 (7.7) 3 (5.5) 0.640 X2 Penile numbness 2 (3.8) 1 (1.8) 0.611 X2 Penile curvature 1 (1.9) 1 (1.8) 1.000 X2 SUI 1 (1.9) 1 (1.8) 1.000 X2 Recurrent stricture 5 (9.6) 5 (9.1) 0.926 X2 First-year success (passing a 16-F cystoscope without difficulty) 48 (92.3) 51 (92.7) 0.934 X2 Upon analyzing the perioperative data (Table 2 ), it was observed that only the operation time and the postoperative catheter time significantly differed between the two groups, both being significantly shorter in the CS group (94.7 ± 7.3 vs. 117.2 ± 5.7 min and 9.9 ± 1.6 vs. 15.8 ± 1.9 min, p = 0.000, respectively). The groups were also similar in terms of anatomical success, SUI, penile numbness, penile curvature, and postoperative infections (urinary tract infection and epididymo-orchitis) (p > 0.05). Lastly, no wound infection or extravasation was observed in the postoperative RGU of any of the patients. Discussion Despite the availability of fewer studies in the literature comparing suture types in the treatment of urethral strictures [ 7 ], there are more studies and meta-analyses examining other procedures in urological reconstructive surgery. The use of CS in pelviureteric anastomosis in pyeloplasty has provided benefits such as reduced operation time and a shorter hospital stay compared to IS, without increasing complication rates or failures [ 8 ]. A meta-analysis comparing absorbable sutures with CS and IS techniques in hypospadias repair reported no significant difference in complications [ 9 ]. Another meta-analysis comparing the suture techniques employed in radical prostatectomy and vesicourethral anastomosis showed that the CS technique was superior in terms of anastomosis time, catheterization time, and extravasation rate [ 10 ]. However, the authors noted that long-term complications such as continence and stricture did not significantly differ between the CS and IS techniques. Theoretically, the CS technique is faster and more advantageous in terms of anastomotic leakage, but it may result in tissue ischemia due to tissue compression between the sutures [ 11 , 12 ]. The IS technique reduces the possibility of postoperative stricture and has the advantage of fixing the urethral stump [ 10 ]. However, a shorter operation time is associated with a decrease in intraoperative and postoperative complication rates [ 13 ]. In our study, the operation time was found to be significantly shorter in the CS group than in the IS group, as expected. Urethral catheters placed after urethroplasty aid in achieving complete mucosal union and prevent urethral distension during voiding. They also help avoid urinoma development by preventing urine extravasation [ 14 ]. However, early removal of the urethral catheter reduces the risk of urinary tract infections and recurrence by minimizing catheter-related problems, such as possible pressure necrosis of the urethral epithelium [ 15 ]. In a randomized study on infective bulbar stricture, Claassen et al. compared double-layer CS and IS during EPA urethroplasty. In the double-layer anastomosis group, the urethral catheter was removed on the first postoperative day, and the patients were discharged. Although the catheter was retained until the 14th postoperative day in the IS group, the rate of surgical success was higher in the CS group, albeit at a statistically non-significant level (90% vs. 71%, p = 0.219). The authors concluded that early removal of the catheter did not worsen the outcomes of EPA urethroplasty [ 7 ]. The most important differences between that study and ours are that we applied single-layer, not double-layer, suturing in the CS technique, and we preferred a V-Loc suture instead of a non-barbed polyglactin suture. In addition, in our study, the etiology was not limited to infective strictures. We achieved a similar success rate with the single-layer CS technique, but the urethral catheter was left in for about a week. Although previous multiple endoscopic interventions are considered to make open reconstruction difficult and reduce success [ 16 ], there are also studies that argue the contrary [ 17 , 18 ]. In our study, the CS and IS groups were similar in terms of both previous endoscopic interventions and first-year anatomical success rates. In the study conducted by Classen et al., although the etiology was infection, no patient developed urosepsis or periurethral abscess [ 7 ]. In our study, no wound infection developed in any of the patients, and the rate of infective complications, such as urinary tract infection and epididymo-orchitis, was 6.5%. In another study conducted with the double-layer anastomosis technique, the rate of urinary extravasation in the early postoperative period was found to be 3% [ 19 ]. In our study, although the catheter was removed a week earlier in the CS group, no extravasation was observed in the postoperative RGU of any of the patients. There are a limited number of publications in the literature that examine the results of suture techniques in EPA urethroplasty [ 7 ]. This limitation is the most important advantage of our study. In our paper, the success criterion was defined as the ability to easily advance a 16-Fr flexible cystoscope into the bladder at the 12th month, which is a more objective criterion than cystoscopy performed in previous studies only on cases with a high suspicion of recurrent stricture. It is important to remember that anastomotic failure may be asymptomatic. A previous study found that 35% of patients with anatomical failure were asymptomatic, accepting success as a 16-17-Fr cystoscope passing through the reconstructed lumen without difficulty [ 20 ]. Furthermore, our study investigated not only anatomical success but also complications that could be considered functional failure, such as SUI, erectile dysfunction, penile numbness, and penile curvature. The most important limitations of our study are the small number of patients and the short follow-up period. In the literature, it has been suggested that the success rates of anastomotic urethroplasty may decrease over time, regardless of the technique; therefore, a long follow-up period is required [ 21 ]. Conclusion No significant difference was observed between the CS and IS suture techniques used in EPA urethroplasty regarding success or complications. However, in addition to reducing the operation time, the CS technique offers the advantage of safely removing the urethral catheter earlier. Further prospective studies are needed to investigate the suture techniques employed in urethroplasty anastomosis. Ethics Committee Approval : The study was approved by Ethics Committee of Basaksehir Cam and Sakura City Hospital (decision number: 2024.02.131) Declarations Ethics Committee Approval: The study was approved by Ethics Committee of Basaksehir Cam and Sakura City Hospital (decision number: 2024.02.131) Informed Consent: An informed consent was obtained from all the patients. Publication: The results of the study were not published in full or in part in the form of abstracts. Conflict of Interest: The authors declare that they have no conflict of interest. Financial Disclosure: The authors declare that this study received no financial support. Author Contribution Conception: YÇ, AŞSupervision: YÇ, AŞFundings: -Materials: -Data Collection: DNÖ, AAAnalysis: MSLiterature Review: YÇ, DNÖWriter: YÇ, DNÖ, AŞCritical Review: MS, AŞ References Smith TG 3rd (2016) Current management of urethral stricture disease. Indian J Urol 32:27–33. https://doi.org/10.4103/0970-1591.173108 . Anger JT, Santucci R, Grossberg AL, Saigal CS (2010) The morbidity of urethral stricture disease among male medicare beneficiaries. BMC Urol. 10:3. https://doi.org/10.1186/1471-2490-10-3 Palminteri E, Berdondini E, Verze P, De Nunzio C, Vitarelli A, Carmignani L (2013) Contemporary urethral stricture characteristics in the developed world. 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Peterson AC, Webster GD (2004) Management of urethral stricture disease: developing options for surgical intervention. BJU Int 94:971–976. https://doi.org/10.1111/j.1464-410X.2004.05088.x . Barbagli G, Palminteri E, Lazzeri M, Guazzoni G, Turini D (2001) Long-term outcome of urethroplasty after failed urethrotomy versus primary repair. J Urol 165(6 Pt 1):1918–1619. https://doi.org/10.1097/00005392-200106000-00018 . Terlecki RP, Steele MC, Valadez C, Morey AF (2011) Low yield of early postoperative imaging after anastomotic urethroplasty. Urology 78:450–453. https://doi.org/10.1016/j.urology.2011.01.071 . Erickson BA, Elliott SP, Voelzke BB, Myers JB, Broghammer JA, Smith TG 3rd, McClung CD, Alsikafi NF, Brant WO; Trauma and Reconstructive Network of Surgeons (TURNS) (2014) Multi-institutional 1-year bulbar urethroplasty outcomes using a standardized prospective cystoscopic follow-up protocol. Urology 84:213–216. https://doi.org/10.1016/j.urology.2014.01.054 . Andrich DE, Dunglison N, Greenwell TJ, Mundy AR (2003) The long-term results of urethroplasty. J Urol 170:90 – 2. https://doi.org/10.1097/01.ju.0000069820.81726.00 . PMID: 12796652. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 09 Oct, 2024 Read the published version in International Urology and Nephrology → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4790632","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":341837383,"identity":"0ff32df2-7c31-4026-8191-00bc7b859b40","order_by":0,"name":"Yunus Çolakoğlu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYDCCAzAGewOQMLAgRQsPiGUgQYoWiQQwSVgH3+0DbNK8Ow7b8898fnXDjwIJBv727gS8WiTPJQC1nDmcOON2TtnNHqDDJM6c3YBXi8EZBqCWtsMJBtI5aTd4gFoMJHKJ02JvIHkm7eYfUrQwbpBgP3abKFskzzA2W85tS0+ccSaH7baMgQQPQb/wnWE+eONtm7U9f/vxZzff/LGR42/vxa+FgYGxBRoXPAZgkoByMGD+AKHZHxCjehSMglEwCkYgAADnY0Rx+OZPWwAAAABJRU5ErkJggg==","orcid":"","institution":"Başakşehir Çam ve Sakura City Hospital","correspondingAuthor":true,"prefix":"","firstName":"Yunus","middleName":"","lastName":"Çolakoğlu","suffix":""},{"id":341837384,"identity":"c9c449c6-f7c9-44d9-bfac-6ef8b819557a","order_by":1,"name":"Deniz Noyan Özlü","email":"","orcid":"","institution":"Bitlis State Hospital","correspondingAuthor":false,"prefix":"","firstName":"Deniz","middleName":"Noyan","lastName":"Özlü","suffix":""},{"id":341837385,"identity":"a93c39c5-85d6-4210-a4e8-64ce34d408c4","order_by":2,"name":"Ali Ayten","email":"","orcid":"","institution":"Bakırköy Dr.Sadi Konuk Eğitim ve Araştırma Hastanesi","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"","lastName":"Ayten","suffix":""},{"id":341837386,"identity":"ee55911d-485d-4f26-9635-81c1ea06ac3f","order_by":3,"name":"Metin Savun","email":"","orcid":"","institution":"Başakşehir Çam ve Sakura City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Metin","middleName":"","lastName":"Savun","suffix":""},{"id":341837387,"identity":"b7eb0fc4-dfc6-4a53-8e48-b313a15ed7e3","order_by":4,"name":"Abdulmüttalip Şimşek","email":"","orcid":"","institution":"Başakşehir Çam ve Sakura City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Abdulmüttalip","middleName":"","lastName":"Şimşek","suffix":""}],"badges":[],"createdAt":"2024-07-23 17:51:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4790632/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4790632/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11255-024-04223-1","type":"published","date":"2024-10-09T15:57:57+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":63299895,"identity":"5550ca7d-9f28-4990-a000-2beab8da7ffb","added_by":"auto","created_at":"2024-08-26 16:00:48","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":109922,"visible":true,"origin":"","legend":"\u003cp\u003eThe urethra sutured with a continuous running suture, starting from the 12 o’clock position, covering the epithelium and spongiosum, and knitting in the opposite direction toward the 6 o’clock position.\u003c/p\u003e","description":"","filename":"Fig.1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4790632/v1/0755a5651bdd3f788404ef34.jpeg"},{"id":63299234,"identity":"258d690f-216c-40c8-b14d-6d0bb2e4e50b","added_by":"auto","created_at":"2024-08-26 15:52:46","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":132287,"visible":true,"origin":"","legend":"\u003cp\u003eThe anastomosis was sutured individually using 5-6 interrupted sutures by including the epithelium and spongiosum.\u003c/p\u003e","description":"","filename":"Fig.2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4790632/v1/1d8f1a00c64a3fa1600bb51c.jpeg"},{"id":66597421,"identity":"9b955804-3954-4dfe-af9c-f192854b85d7","added_by":"auto","created_at":"2024-10-14 16:10:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":687832,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4790632/v1/c0e7cf2c-82f1-406f-a7b5-c9c189e8737b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Does the Suturing Technique (Barbed Continuous versus Conventional Interrupted) Have an Impact on the Outcome of Anastomotic Urethroplasty?","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUrethral stricture is a frequently recurrent disease that progresses with fibrosis of the urethral mucosa and spongiosa tissue, significantly reducing the quality of life of patients [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Although the true incidence of the disease remains uncertain, Medicare data from the USA showed an annual incidence of 0.9% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Approximately 50% of urethral strictures occur in the bulbar urethra, 30% in the penile urethra, and the remainder in a combination of the two [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eExcision and primary anastomosis (EPA) urethroplasty is considered the gold standard treatment, with a success rate of over 90% for strictures smaller than 2 cm, which constitute the majority of cases [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Although absorbable sutures are mostly utilized in urethroplasty, there are major variations among surgeons concerning their preference for the continuous suture (CS) or interrupted suture (IS) technique.\u003c/p\u003e \u003cp\u003eIn this study, we aimed to evaluate and compare CS and IS techniques applied in EPA urethroplasty in terms of surgical success and complication rates.\u003c/p\u003e"},{"header":"Material and Method","content":"\u003cp\u003eFollowing the approval of the Ethics Committee of Basaksehir Cam and Sakura City Hospital (decision number: 2024.02.131), patients who underwent EPA between April 2020 and December 2022 were evaluated retrospectively. Male patients aged 18 to 75 who underwent primary urethroplasty were included in the study.\u003c/p\u003e \u003cp\u003eThe stricture length to be used as an indication of anastomotic urethroplasty remains controversial. A previous study found no significant difference in success between strictures shorter than and longer than 2 cm [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Patients with \u0026le;\u0026thinsp;2.5 cm bulbar urethral strictures were included in our study. Excluded from the study were patients who had previously undergone urethral reconstruction, those with multiple strictures, and those with a history of pelvic radiotherapy, but not those who had received endoscopic urethral stricture treatment. Additionally, patients diagnosed with Lichen sclerosus, those with a previous history of surgery due to congenital penile curvature or Peyronie\u0026rsquo;s disease, and those with a follow-up period of less than 12 months were excluded.\u003c/p\u003e \u003cp\u003eBefore surgery, urea, creatinine, complete urinalysis, urine culture, coagulation, uroflowmetry, urinary system ultrasonography, clinical history, antegrade and/or retrograde urethrography (RGU), and flexible urethrocystoscopy (for determination of the length and location of urethral stricture) examinations were performed on all patients. The patients\u0026rsquo; age, body mass index (BMI), number of preoperative direct vision internal urethrotomy (DVIUs) performed, stricture length, preoperative and postoperative maximum flow rates on uroflowmetry (Q\u003csub\u003emax\u003c/sub\u003e), operation times, preoperative and postoperative International Index of Erectile Function-5 (IIEF-5) scores, anatomical success rates, and postoperative stress urinary incontinence (SUI), penile numbness, penile curvature, and infectious complications were compared. Preoperative urine culture sterility was required for all patients. Patients with growth in culture were treated with appropriate antibiotics. All patients were administered broad-spectrum intravenous antibiotics (e.g., 2 g of ceftriaxone) before surgery.\u003c/p\u003e \u003cp\u003eThe patients were divided into two groups according to the suture technique used during EPA: Continue suture group: CS, and Interrupted Suture group: IS. The groups were compared for demographic and perioperative data.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSurgical technique\u003c/h2\u003e \u003cp\u003eUrethroplasty procedures were performed by two experienced (\u0026gt;\u0026thinsp;100 cases/year) surgeons (AŞ, Y\u0026Ccedil;). The patients were placed in the exhausted lithotomy position under general anesthesia. A vertical incision was made in the perineum, and a ring retractor (Turner Warwick ring retractor) was placed after the incision of Colles\u0026rsquo; fascia. The bulbocavenous muscle was separated from the midline to access the bulbar urethra. A cystoscopy was used to identify the distal end of the stricture, and a suspension suture was placed under the guidance of the cystoscopy image. Then, the urethra was circumferentially mobilized from the corpus cavernosum, and the stenosis area was transected and excised. In the CS group, after spatulation of the urethral ends, two segments of 3/0 V-Loc suture (Covidien Healthcare, Mansfield, MA, USA), joined together, were used for end-to-end urethral anastomosis, starting from the 12 o\u0026rsquo;clock position, covering the epithelium and spongiosum, and knitting in the opposite direction toward the 6 o\u0026rsquo;clock position (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In the IS group, the anastomosis was sutured individually using 5\u0026ndash;6 3/0 Vicryl (Ethicon, Inc., Somerville, NJ, USA) by including the epithelium and spongiosum (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). After anastomosis, an 18-Fr Foley catheter was placed in the bladder. Following the completion of the anastomosis in both groups, the urethra was fixed to the surrounding tissue. The bulbospongiosus muscle was closed over the urethra. A drain was not placed routinely.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe urethral catheters were removed in the first week after discharge for the patients in the CS group and in the second week after discharge for those in the IS group. Pericatheter RGU was performed on all patients before catheter removal, and the absence of extravasation was confirmed. Subsequently, all patients were followed up with control cystoscopies at the third and 12th months. The anatomical success of the surgery was defined as being able to easily advance a 16-Fr flexible cystoscope into the bladder at the 12th month [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eMean, standard deviation, median, minimum, maximum, frequency, and ratio values were used as the descriptive statistics of the data. The distribution of variables was measured using the Kolmogorov-Smirnov and Shapiro-Wilk tests. The independent-samples t-test and the Mann-Whitney U test were used for the analysis of quantitative independent data. The paired-samples t-test and the Wilcoxon test were conducted to analyze dependent quantitative data. The chi-square test was used in the analysis of qualitative independent data, and the Fischer test was used when the chi-square test conditions were not met. SPSS v. 27.0 was used for statistical analyses.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study included a total of 97 patients: 52 (53.6%) in the CS group and 55 (46.4%) in the IS group. The mean age of the patients was calculated to be 56.2 years. In the entire patient group, the mean stenosis length was 19.3 mm, the mean number of preoperative DVIUs was 2.4, and the rate of preoperative suprapubic catheterization was 24.3%. The demographic and perioperative data of the patients are given in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and perioperative data of the entire patient group BMI: Body mass index, IIEF-5: International Index of Erectile Function-5, UTI: Urinary tract infection, SUI: Stress urinary incontinence\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD / n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56.2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStricture length (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ\u003csub\u003emax\u003c/sub\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003ePreoperative\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003ePostoperative\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e \u003cp\u003e22.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative number of urethrotomies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative suprapubic catheterization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (24.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIIEF-5 score\u003c/p\u003e \u003cp\u003e\u003cem\u003ePreoperative\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003ePostoperative\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eChange\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e \u003cp\u003e20.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1\u003c/p\u003e \u003cp\u003e1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative data\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e106.3\u0026thinsp;\u0026plusmn;\u0026thinsp;13.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of hospital stay (day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative catheter time (day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative infection (UTI, orchitis, and epididymitis)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (6.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePenile numbness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePenile curvature\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSUI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecurrent stricture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (9.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst-year success (passing a 16-F cystoscope without difficulty)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99 (92.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the comparative analysis of the CS and IS groups. The two groups were similar in terms of age, BMI, stricture length, number of preoperative DVIUs, and the presence of suprapubic catheterization (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Although there was a borderline statistical non-significance in the comparison of the preoperative IIEF-5 scores of the CS and IS groups (18.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4 vs. 20.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1, p\u0026thinsp;=\u0026thinsp;0.055), postoperative changes in these scores were statistically similar (1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3 vs. 0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4, p\u0026thinsp;=\u0026thinsp;0.284).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparative analysis of preoperative and postoperative data between the suture groups BMI: Body mass index, IIEF-5: International Index of Erectile Function-5, UTI: Urinary tract infection, SUI: Stress urinary incontinence\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD / n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContinuous suture group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInterrupted suture group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.6\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.617\u003csup\u003et\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.235\u003csup\u003em\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStricture length (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.572\u003csup\u003em\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ\u003csub\u003emax\u003c/sub\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003ePreoperative\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003ePostoperative\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e \u003cp\u003e22.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003cp\u003e22.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.238\u003csup\u003em\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e0.881\u003csup\u003et\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative number of DVIUs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.314\u003csup\u003em\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative suprapubic catheterization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (26.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (21.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.538\u003csup\u003eX2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIIEF-5\u003c/p\u003e \u003cp\u003e\u003cem\u003ePreoperative\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003ePostoperative\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eChange\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eIntragroup change p\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e \u003cp\u003e19.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e \u003cp\u003e1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003csup\u003eW\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1\u003c/p\u003e \u003cp\u003e20.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.038\u003c/b\u003e\u003csup\u003eW\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.055\u003csup\u003em\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e0.197\u003csup\u003em\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e0.284\u003csup\u003em\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative data\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003csup\u003e\u003cem\u003em\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of hospital stay (day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.680\u003csup\u003em\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative catheter time (day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003csup\u003e\u003cem\u003em\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative infection (UTI, orchitis, and epididymitis)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.640\u003csup\u003eX2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePenile numbness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.611\u003csup\u003eX2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePenile curvature\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003csup\u003eX2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSUI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003csup\u003eX2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecurrent stricture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.926\u003csup\u003eX2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst-year success (passing a 16-F cystoscope without difficulty)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (92.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (92.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.934\u003csup\u003eX2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eUpon analyzing the perioperative data (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), it was observed that only the operation time and the postoperative catheter time significantly differed between the two groups, both being significantly shorter in the CS group (94.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3 vs. 117.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7 min and 9.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 vs. 15.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9 min, p\u0026thinsp;=\u0026thinsp;0.000, respectively). The groups were also similar in terms of anatomical success, SUI, penile numbness, penile curvature, and postoperative infections (urinary tract infection and epididymo-orchitis) (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Lastly, no wound infection or extravasation was observed in the postoperative RGU of any of the patients.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDespite the availability of fewer studies in the literature comparing suture types in the treatment of urethral strictures [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], there are more studies and meta-analyses examining other procedures in urological reconstructive surgery. The use of CS in pelviureteric anastomosis in pyeloplasty has provided benefits such as reduced operation time and a shorter hospital stay compared to IS, without increasing complication rates or failures [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. A meta-analysis comparing absorbable sutures with CS and IS techniques in hypospadias repair reported no significant difference in complications [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Another meta-analysis comparing the suture techniques employed in radical prostatectomy and vesicourethral anastomosis showed that the CS technique was superior in terms of anastomosis time, catheterization time, and extravasation rate [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, the authors noted that long-term complications such as continence and stricture did not significantly differ between the CS and IS techniques.\u003c/p\u003e \u003cp\u003eTheoretically, the CS technique is faster and more advantageous in terms of anastomotic leakage, but it may result in tissue ischemia due to tissue compression between the sutures [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The IS technique reduces the possibility of postoperative stricture and has the advantage of fixing the urethral stump [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, a shorter operation time is associated with a decrease in intraoperative and postoperative complication rates [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In our study, the operation time was found to be significantly shorter in the CS group than in the IS group, as expected.\u003c/p\u003e \u003cp\u003eUrethral catheters placed after urethroplasty aid in achieving complete mucosal union and prevent urethral distension during voiding. They also help avoid urinoma development by preventing urine extravasation [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, early removal of the urethral catheter reduces the risk of urinary tract infections and recurrence by minimizing catheter-related problems, such as possible pressure necrosis of the urethral epithelium [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In a randomized study on infective bulbar stricture, Claassen et al. compared double-layer CS and IS during EPA urethroplasty. In the double-layer anastomosis group, the urethral catheter was removed on the first postoperative day, and the patients were discharged. Although the catheter was retained until the 14th postoperative day in the IS group, the rate of surgical success was higher in the CS group, albeit at a statistically non-significant level (90% vs. 71%, p\u0026thinsp;=\u0026thinsp;0.219). The authors concluded that early removal of the catheter did not worsen the outcomes of EPA urethroplasty [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The most important differences between that study and ours are that we applied single-layer, not double-layer, suturing in the CS technique, and we preferred a V-Loc suture instead of a non-barbed polyglactin suture. In addition, in our study, the etiology was not limited to infective strictures. We achieved a similar success rate with the single-layer CS technique, but the urethral catheter was left in for about a week.\u003c/p\u003e \u003cp\u003eAlthough previous multiple endoscopic interventions are considered to make open reconstruction difficult and reduce success [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], there are also studies that argue the contrary [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In our study, the CS and IS groups were similar in terms of both previous endoscopic interventions and first-year anatomical success rates.\u003c/p\u003e \u003cp\u003eIn the study conducted by Classen et al., although the etiology was infection, no patient developed urosepsis or periurethral abscess [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In our study, no wound infection developed in any of the patients, and the rate of infective complications, such as urinary tract infection and epididymo-orchitis, was 6.5%. In another study conducted with the double-layer anastomosis technique, the rate of urinary extravasation in the early postoperative period was found to be 3% [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In our study, although the catheter was removed a week earlier in the CS group, no extravasation was observed in the postoperative RGU of any of the patients.\u003c/p\u003e \u003cp\u003eThere are a limited number of publications in the literature that examine the results of suture techniques in EPA urethroplasty [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This limitation is the most important advantage of our study. In our paper, the success criterion was defined as the ability to easily advance a 16-Fr flexible cystoscope into the bladder at the 12th month, which is a more objective criterion than cystoscopy performed in previous studies only on cases with a high suspicion of recurrent stricture. It is important to remember that anastomotic failure may be asymptomatic. A previous study found that 35% of patients with anatomical failure were asymptomatic, accepting success as a 16-17-Fr cystoscope passing through the reconstructed lumen without difficulty [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Furthermore, our study investigated not only anatomical success but also complications that could be considered functional failure, such as SUI, erectile dysfunction, penile numbness, and penile curvature.\u003c/p\u003e \u003cp\u003eThe most important limitations of our study are the small number of patients and the short follow-up period. In the literature, it has been suggested that the success rates of anastomotic urethroplasty may decrease over time, regardless of the technique; therefore, a long follow-up period is required [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eNo significant difference was observed between the CS and IS suture techniques used in EPA urethroplasty regarding success or complications. However, in addition to reducing the operation time, the CS technique offers the advantage of safely removing the urethral catheter earlier. Further prospective studies are needed to investigate the suture techniques employed in urethroplasty anastomosis.\u003c/p\u003e \u003cp\u003e\u003cb\u003eEthics Committee Approval\u003c/b\u003e: The study was approved by Ethics Committee of Basaksehir Cam and Sakura City Hospital (decision number: 2024.02.131)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Committee Approval:\u003c/strong\u003e The study was approved by Ethics Committee of Basaksehir Cam and Sakura City Hospital (decision number: 2024.02.131)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent:\u003c/strong\u003e An informed consent was obtained from all the patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePublication:\u003c/strong\u003e The results of the study were not published in full or in part in the form of abstracts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e The authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial Disclosure:\u003c/strong\u003e The authors declare that this study received no financial support.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConception: Y\u0026Ccedil;, AŞSupervision: Y\u0026Ccedil;, AŞFundings: -Materials: -Data Collection: DN\u0026Ouml;, AAAnalysis: MSLiterature Review: Y\u0026Ccedil;, DN\u0026Ouml;Writer: Y\u0026Ccedil;, DN\u0026Ouml;, AŞCritical Review: MS, AŞ\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSmith TG 3rd (2016) Current management of urethral stricture disease. 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Urology 78:450\u0026ndash;453. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.urology.2011.01.071\u003c/span\u003e\u003cspan address=\"10.1016/j.urology.2011.01.071\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErickson BA, Elliott SP, Voelzke BB, Myers JB, Broghammer JA, Smith TG 3rd, McClung CD, Alsikafi NF, Brant WO; Trauma and Reconstructive Network of Surgeons (TURNS) (2014) Multi-institutional 1-year bulbar urethroplasty outcomes using a standardized prospective cystoscopic follow-up protocol. Urology 84:213\u0026ndash;216. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.urology.2014.01.054\u003c/span\u003e\u003cspan address=\"10.1016/j.urology.2014.01.054\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAndrich DE, Dunglison N, Greenwell TJ, Mundy AR (2003) The long-term results of urethroplasty. J Urol 170:90\u0026thinsp;\u0026ndash;\u0026thinsp;2. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/01.ju.0000069820.81726.00\u003c/span\u003e\u003cspan address=\"10.1097/01.ju.0000069820.81726.00\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 12796652.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"urethral stricture, anastomotic urethroplasty, continuous suture, interrupted suture, suture techniques","lastPublishedDoi":"10.21203/rs.3.rs-4790632/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4790632/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eTo evaluate and compare continuous suture (CS) and interrupted suture (IS) techniques applied in excision and primary anastomosis (EPA) urethroplasty in terms of surgical success and complication rates.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective evaluation was conducted on patients with bulbar urethral strictures measuring\u0026thinsp;\u0026le;\u0026thinsp;2.5 cm, who underwent EPA between April 2020 and December 2022. Patients with a history of urethral reconstruction, multiple strictures, a history of pelvic radiotherapy, a diagnosis of Lichen sclerosis, a history of surgery due to congenital penile curvature or Peyronie\u0026rsquo;s disease, and a follow-up period of less than 12 months were excluded. The patients were divided into two groups according to the suture technique used (CS or IS), and the groups were compared for demographic and perioperative data.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 97 patients (CS: n\u0026thinsp;=\u0026thinsp;52, IS: n\u0026thinsp;=\u0026thinsp;55) were included in the sample. The mean age of the entire patient group was calculated to be 56.2 years, and the mean stricture length was 19.3 mm. Operation time and postoperative catheter time were shorter in the CS group (94.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3 vs. 117.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7 min and 9.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 vs. 15.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9 min, p\u0026thinsp;=\u0026thinsp;0.000, respectively). The groups were similar regarding anatomical success, stress urinary incontinence, penile numbness, curvature, and postoperative infection (p\u0026thinsp;\u0026gt;\u0026thinsp;0.0).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eNo significant difference was observed between the CS and IS techniques employed during EPA urethroplasty in terms of success or complications. However, in addition to reducing the operation time, the CS technique offers the advantage of safely removing the urethral catheter earlier.\u003c/p\u003e","manuscriptTitle":"Does the Suturing Technique (Barbed Continuous versus Conventional Interrupted) Have an Impact on the Outcome of Anastomotic Urethroplasty?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-26 15:52:42","doi":"10.21203/rs.3.rs-4790632/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"faae7578-0edf-41c2-833c-e92befb0a492","owner":[],"postedDate":"August 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-14T16:06:27+00:00","versionOfRecord":{"articleIdentity":"rs-4790632","link":"https://doi.org/10.1007/s11255-024-04223-1","journal":{"identity":"international-urology-and-nephrology","isVorOnly":false,"title":"International Urology and Nephrology"},"publishedOn":"2024-10-09 15:57:57","publishedOnDateReadable":"October 9th, 2024"},"versionCreatedAt":"2024-08-26 15:52:42","video":"","vorDoi":"10.1007/s11255-024-04223-1","vorDoiUrl":"https://doi.org/10.1007/s11255-024-04223-1","workflowStages":[]},"version":"v1","identity":"rs-4790632","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4790632","identity":"rs-4790632","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}