title: Use of Scaffolding Tissue Biografts To Bolster Vesicourethral Anastomosis During Salvage Robot-assisted Prostatectomy Reduces Leak Rates and Catheter Times.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  sRARP with use of a UB-ECM scaffold in the posterior aspect of the VUA and distal bladder neck.
  
  
  
  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 χ2test was used to test categorical variables.
  
  
  
  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).
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA. Electronic address: gabriel.ogayapinies@flhosp.org.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Ogaya-Pinies
authors.affiliation: Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA.
authors.forename: Yash
authors.initials: Y
authors.lastname: Kadakia
authors.affiliation: Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA.
authors.forename: Hariharan
authors.initials: H
authors.lastname: Palayapalayam-Ganapathi
authors.affiliation: Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA.
authors.forename: Tracey
authors.initials: T
authors.lastname: Woodlief
authors.affiliation: Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA.
authors.forename: Cathy
authors.initials: C
authors.lastname: Jenson
authors.affiliation: University of Florida College of Medicine, Department of Urology, Gainesville, FL, USA.
authors.forename: Jamil
authors.initials: J
authors.lastname: Syed
authors.affiliation: Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA.
authors.forename: Vipul
authors.initials: V
authors.lastname: Patel
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control; D005109:Extracellular Matrix / Q000637:transplantation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D011467:Prostate / Q000601:surgery; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery* / Q000628:therapy; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D016879:Salvage Therapy; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000517:prevention & control; D054457:Tissue Scaffolds; D014183:Transplantation, Heterologous; D014521:Urethra / Q000601:surgery; D001743:Urinary Bladder / Q000601:surgery; D014546:Urinary Catheterization; D014549:Urinary Incontinence / Q000209:etiology / Q000517:prevention & control
keywords: Anastomotic leaks; Biomaterials; Prostate cancer; Salvage robotic prostatectomy; Scaffold