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

Jamie Krishnan; Rory Brennan; Osman El-Koubani; Sailantra Sivathasan; Kevin Gallagher; Linda Taylor; Abhishek Sharma; Daniel Good; Alan McNeill

doi:10.1002/bco2.70023

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

BJUI Compass. 2025 Jul 2;6(7):e70023. doi: 10.1002/bco2.70023. eCollection 2025 Jul.

Authors

Jamie Krishnan¹, Rory Brennan¹, Osman El-Koubani¹, Sailantra Sivathasan¹, Kevin Gallagher¹, Linda Taylor¹, Abhishek Sharma¹, Daniel Good¹, Alan McNeill¹

Affiliation

¹ Western General Hospital Edinburgh UK.

Abstract

Objective: 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.

Methods: 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 (REDCap^Ò) 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.

Results: 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).

Conclusions: 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.

Keywords: RARP; UTI; anastamotic leak; cystogram; haemostatic agent; prostatectomy.