Closure of the Urinary Bladder with Stainless Steel and Absorbable Staples

Abstract

Stapling is widely accepted in the field of pulmonary and gastrointestinal surgery. However, this has not been the case in urinary tract surgery, presumably because of the possibility of stone formation on the staples. In addressing the issue, both stainless steel staples and absorbable staples (PolysorbTM) were evaluated in 104 linear stapled closures of dog bladders. The mucosa to mucosa closures were performed in bladders with sterile, acutely infected, and chronically infected urine. Staple lines were resected and examined both grossly and microscopically at periods from 1 week to 4 months after the closures. No animal suffered a clinical leak or abscess formation. Four steel closures developed exposed staples, one of which developed a small amount of crystal formation. Twenty-nine absorbable closures contained exposed staples in which two closures developed crystal formation. All closures were secure and healed without difficulty. It appears that closure of the bladder with stainless or absorbable staples is safe and effective.

A transperitoneal laparoscopic approach to endourology

“…It should be noted, however, that the occurrence of staple-associated lithiasis among patients undergoing stainless-steel-stapled closure of the proximal end of an ileal conduit has been only 4% [10,11]. Furthermore, most intravesical staples become covered by urothelium when used in bladder surgery and are therefore shielded from contact with urine [12]. To explore the possibility of using metal staples for laparoscopic ureteral reconstructive surgery, Maxwell et al [13•] experimented with the use of nonperforating titanium vascular closure staple clips (US Surgical, Norwalk, CT) during porcine laparoscopic ureteroureterostomy.…”