Application of fibrin sealant at the urethrovesical anastomosis in robotic assisted radical prostatectomy: does it enable earlier Foley catheter and Jackson–Pratt drain removal?

Leakage at the urethrovesical anastomosis in the post-operative period can result in morbidity including ileus. We examined the effectiveness of using a fibrin sealant at the anastomosis to limit urine leakage thereby facilitating earlier Jackson-Pratt drain and Foley catheter removal following robotic assisted laparoscopic prostatectomy (RALRP). Forty consecutive patients underwent RALRP by one surgeon at our institution. The first 20 patients underwent standard operation and served as the control group. The subsequent 20 patients underwent the same operation with addition of fibrin sealant following a running absorbable sutured urethrovesical anastomosis. The two groups were compared for age (60.5 vs. 58.2 years), pre-operative PSA (5.23 vs. 4.71), Gleason score (6.3 vs. 6.5), stage at resection, and prostate size at resection (51.7 vs. 47.7 g). Wilcoxon rank sum test determined no statistically significant differences in the groups. Patients in the fibrin sealant group had 1.3 versus 2.1 days with a Jackson-Pratt drain, 9.75 versus 12.1 days with a catheter, and an average of 38.6 versus 63.2 cc of drainage per shift. Catheters were removed when a cystogram demonstrated no extravasation of contrast. Two patients in the control group and no patients in the fibrin sealant group had large-volume leakage and ileus post-operatively. In patients undergoing RALRP, application of fibrin sealant at the urethrovesical anastomosis appears to facilitate sealing, thereby allowing earlier removal of the JP drain, by 0.8 days, and the Foley catheter, by 2.35 days, than in controls. No patients in the fibrin sealant group suffered post-operative ileus. This adjunct may be especially useful early in the learning process to reduce morbidity.