Haemostat Use in Prostate Surgery Reduces Infection and Leak Risks

What is it about?

The study evaluates the impact of switching from Oxitamp gauze to Arista AH powder as a haemostatic agent in robotic-assisted radical prostatectomy (RARP) on postoperative outcomes, specifically anastomotic leaks and urinary tract infections (UTIs). Conducted in two phases, it involved 154 patients using Oxitamp and 62 patients using Arista AH. Results indicate a significant reduction in leaks, from 29% with Oxitamp to 15% with Arista AH, alongside a slight decrease in UTIs. The study suggests that routine postoperative cystograms may be unnecessary for all patients, recommending a selective approach primarily for older patients, those needing bladder neck reconstruction, and those with a history of TURP or radiotherapy. This could reduce unnecessary radiation exposure and improve patient quality of life.

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Why is it important?

This research is significant because it evaluates the effectiveness of different haemostatic agents in robotic-assisted radical prostatectomy (RARP) and their impact on postoperative complications such as anastomotic leaks and urinary tract infections (UTIs). The study's findings could lead to improved surgical outcomes, reduced patient morbidity, and more efficient use of medical resources. By identifying factors that influence the need for postoperative cystograms, the research contributes to developing a more selective approach in post-RARP care, potentially reducing unnecessary procedures, radiation exposure, and improving overall patient experience. Key Takeaways: 1. Haemostatic Agent Efficacy: The study demonstrates that changing from Oxitamp gauze to Arista AH powder as a haemostatic agent reduced the incidence of anastomotic leaks from 29% to 15%, suggesting improved surgical outcomes with the newer agent. 2. Selective Cystogram Approach: The research proposes a more targeted approach to postoperative cystograms, recommending them only for specific patient groups (e.g., those >70 years, needing bladder neck reconstruction, or with a history of TURP or radiotherapy), which could lead to more efficient resource utilization and reduced patient discomfort. 3. UTI and Leak Correlation: The study highlights a potential correlation between postoperative UTIs and anastomotic leaks, with a notable reduction in leak-associated UTIs when using Arista AH (from 79% to 14%), emphasizing the importance of proper haemostatic agent selection in reducing postoperative complications.