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Surgery in Motion

Use of Scaffolding Tissue Biografts To Bolster Vesicourethral Anastomosis During Salvage Robot-assisted Prostatectomy Reduces Leak Rates and Catheter Times

By: Gabriel Ogaya-Pinies , Yash Kadakia, Hariharan Palayapalayam-Ganapathi, Tracey Woodlief, Cathy Jenson and Vipul Patel

European Urology, December 2016

Published online: 17 December 2016

Keywords: Scaffold, Prostate cancer, Anastomotic leaks, Salvage robotic prostatectomy, Biomaterials

Abstract Full Text Full Text PDF (2,5 MB)

Abstract

Background

One of the key factors contributing to morbidity associated with salvage radical prostatectomy is a significant vesicourethral anastomosis (VUA) disruption or postoperative tissue dehiscence in the region of the distal bladder neck that causes a large prolonged urinary leak, perineal pain, and delayed catheter removal.

Objective

To describe our surgical technique using a urinary bladder extracellular matrix (UB-ECM) scaffold incorporated into the base of the VUA and the distal bladder neck during salvage robot-assisted radical prostatectomy (sRARP) and to assess outcomes and safety.

Design, setting, and participants

From March to July 2015, 15 patients underwent sRARP performed after primary therapy failure by a single surgeon. Two other groups were identified via analysis of propensity score matching. Group 2 (n = 45) underwent sRARP with standard suturing without use of the graft. Group 3 (control group; n = 45) underwent primary RARP with no graft placement. These two groups were compared group 1 (n = 15), in which patients underwent sRARP and received the scaffold in a 1:3:3 match.

Surgical procedure

sRARP with use of a UB-ECM scaffold in the posterior aspect of the VUA and distal bladder neck.

Outcome measurements and statistical analysis

Clinical data were prospectively collected in a customized database and retrospectively analyzed. Analysis of variance and Student's t-test were used to test the equality of means for continuous variables, while the χ2 test was used to test categorical variables.

Results and limitations

There were no anastomotic leaks in the control group, with an average catheter time of 6.3 d (5–7 d). However, a clinically significant VUA/bladder neck disruption was observed in 16 patients (35.5%) in group 2, with a median catheterization time of 17.4 d (9–47 d), while in group 1 only one patient (6.66%) had a significant anastomotic leak on cystography (p = 0.045), with median catheterization time of 11.2 d (10–52 d) for this group (p < 0.05).

Conclusions

Incorporation of a UB-ECM scaffold into the base of the VUA and distal bladder neck should be considered as an option to decrease morbidity associated with sRARP since it decreased the rate of VUA disruption, enhanced healing, and reduced catheterization time. This technique could be a valuable tool for all surgeons performing sRARP.

Patient summary

We investigated the use of a scaffolding tissue graft when connecting the urethra to the bladder during salvage robot-assisted laparoscopic prostatectomy. This technique was found to be effective and safe.

Take Home Message

In this feasibility study, a urinary bladder extracelluar matrix scaffold was placed in the base of the vesicourethral anastomosis/distal bladder neck during salvage robot-assisted radical prostatectomy. This approach resulted in lower morbidity, as evidence by a decrease in the number of clinically significant anastomotic disruptions and a reduction in median catheterization time. Use of this scaffold seems to be safe, as no increase in the the risk of other complications was observed.

Keywords: Scaffold, Prostate cancer, Anastomotic leaks, Salvage robotic prostatectomy, Biomaterials.

Footnotes

a Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA

b University of Florida College of Medicine, Department of Urology, Gainesville, FL, USA

Corresponding author. Global Robotics Institute, Florida Hospital-Celebration Health, 410 Celebration Place, Celebration, FL 34747, USA. Tel. +1 407 3034673; Fax: +1 407 3034674.

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