The impact of haemostatic agent used during robot‐assisted radical prostatectomy on post‐op infection and anastomotic leak

TL;DR

This study compares two haemostatic agents in robot-assisted prostate surgery, finding that one reduces post-op infections and leaks, allowing more selective use of cystograms.

Contribution

The study introduces a novel comparison of haemostatic agents (Oxitamp vs. Arista AH) and their impact on postoperative outcomes in robot-assisted radical prostatectomy.

Findings

Using Arista AH reduced post-op UTIs from 12% to 11% and cystogram leaks from 29% to 15%.

All leaks in the Arista AH group were small, compared to 20% in the Oxitamp group.

Cystograms can be selectively used when Arista AH is applied, except in specific patient cases.

Abstract

Despite the widespread use of robotic‐assisted radical prostatectomy (RARP), considerable variation exists in practice with regard to postoperative cystograms prior to trial without catheter (TWOC).

Our practice was to undertake a cystogram at 7–14‐day post‐op and proceed with TWOC if the leak was small or absent.

In this study, we evaluate the risk factors for anastomotic leak and post‐op urinary tract infection (UTI), while assessing the impact of using powdered haemostat Arista AH on post‐op UTIs and cystographic leaks to rationalise the use of cystograms.

The study was carried out in two phases, the first a retrospective review of 154 patients undergoing RARP between January and October 2022, where Oxitamp (an absorbable haemostat of oxidised regenerated cellulose) was used as the haemostatic agent.

The second phase was prospective, involving 62 patients between November and June 2023, in whom the powdered haemostat Arista AH (microporous polysaccharide haemospheres) was used instead.

Data were collated from a prospectively collected database (REDCapÒ) and electronic patient records. RARP was performed by two experienced surgeons using similar techniques. Analysis was carried out on R‐studios, using Fisher's exact test for categorical variables and unpaired student t‐test for continuous variables.

Post‐op UTI occurred in 19 (12%) patients in Cohort 1 (with Oxitamp) and leaks were associated with 15 (79%). In comparison, seven (11%) patients in Cohort 2 (with Arista AH) suffered from post‐op UTI, and only one (14%) was associated with leak.

There was an overall reduction in leaks on post‐op cystograms from 44 (29%) in Cohort 1 to only nine (15%) in Cohort 2 (p = 0.036).

One hundred per cent of the leaks in Cohort 2 were small, compared to nine (20%) in Cohort 1 (p = 0.0002).

A selective approach can be implemented with regard to post‐op cystograms.

We propose that when using Arista AH cystograms should be carried out in patients in need of bladder neck reconstruction. We will also continue to undertake routine cystograms in those with a history of transurethral resection of prostate (TURP) or in salvage prostatectomy cases.

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