Application of fibrin sealant at the urethrovesical anastomosis in robotic assisted radical prostatectomy: does it enable earlier Foley catheter and Jackson–Pratt drain removal?

Abstract

Leakage at the urethrovesical anastomosis in the post-operative period can result in morbidity including ileus. We examined the eVectiveness of using a Wbrin sealant at the anastomosis to limit urine leakage thereby facilitating earlier Jackson-Pratt drain and Foley catheter removal following robotic assisted laparoscopic prostatectomy (RALRP). Forty consecutive patients underwent RALRP by one surgeon at our institution. The Wrst 20 patients underwent standard operation and served as the control group. The subsequent 20 patients underwent the same operation with addition of Wbrin sealant following a running absorbable sutured urethrovesical anastomosis. The two groups were compared for age (60.5 vs. 58.2 years), preoperative PSA (5.23 vs. 4.71), Gleason score (6.3 vs. 6.5), stage at resection, and prostate size at resection (51.7 vs. 47.7 g). Wilcoxon rank sum test determined no statistically signiWcant diVerences in the groups. Patients in the Wbrin sealant group had 1.3 versus 2.1 days with a Jackson-Pratt drain, 9.75 versus 12.1 days with a catheter, and an average of 38.6 versus 63.2 cc of drainage per shift. Catheters were removed when a cystogram demonstrated no extravasation of contrast. Two patients in the control group and no patients in the Wbrin sealant group had large-volume leakage and ileus post-operatively. In patients undergoing RALRP, application of Wbrin sealant at the urethrovesical anastomosis appears to facilitate sealing, thereby allowing earlier removal of the JP drain, by 0.8 days, and the Foley catheter, by 2.35 days, than in controls. No patients in the Wbrin sealant group suVered post-operative ileus. This adjunct may be especially useful early in the learning process to reduce morbidity.

Bacterial cellulose to reinforce urethrovesical anastomosis. A translational study

“…Fibrin glue and some polymers, such as cyanoacrylate and BioGlue  (albumin and glutaraldehyde) have already been studied. According to Flury et al 10 , the presence of fibrin glue at the anastomosis site seems to facilitate the sealing of the surgical site, thus allowing removal of the JP (Jackson Pratt) cavity drain after 0.8 days and the Foley catheter after 2.35 days of PR. Another material tested by Hruby et al 11 in a pig animal model was BioGlue ® , a combination of glutaraldehyde and purified bovine albumin.…”