A pilot study to investigate the effect of topical microporous polysaccharide haemospheres on outcomes following robot-assisted radical prostatectomy

Ann R Coll Surg Engl. 2022 Jan;104(1):24-27. doi: 10.1308/rcsann.2021.0128. Epub 2021 Nov 3.

Abstract

Introduction: Controlling bleeding without disturbing the anatomy and function of the structures in the prostate bed remains a significant challenge during radical prostatectomy (RP).

Materials and methods: Five grams of powdered microporous polysaccharide haemospheres (MPH) was applied to the prostate bed at the end of robot-assisted RP in 422 consecutive patients. Continence was defined as no pads and potency as the ability to have penetrative sex with or without PDE5 inhibitors in previously potent, non-diabetic men aged <70 years following bilateral intra- or inter-fascial neurovascular bundle (NVB) preservation.

Results: In total, 95.3% of patients had nerve preservation and the mean operating time and blood loss were 142 minutes and 200ml, respectively. There were no intraoperative complications, and the postoperative transfusion rate was 0.2%. The mean hospital stay was 1.7 nights, and duration of catheterisation was 12 days. Final pathology demonstrated a mean prostate weight of 40.0g and 14.5% replacement by cancer, most commonly Gleason 7. The positive surgical margin rate for pT2 tumours was 10.0%. Biochemical recurrence was 2.1% at a mean follow-up of 18.0 months. Continence and potency rates at 4 weeks and 1 year after surgery were 76.4% and 97.7% and 27.8% and 78.1%, respectively. The trifecta and pentafecta rates 1 year after surgery were 53.1% and 45.8%.

Discussion and conclusion: Powdered MPH applied to the prostate bed at the end of robot-assisted RP appears to be a safe, easily applied and useful adjunct to conventional haemostasis. The suggestion that it might also improve the functional outcomes of RP merits further investigation in the context of a randomised trial.

Keywords: Continence; Nerve preservation; Pentafecta; Potency; Prostate cancer; Radical prostatectomy; Robotic surgery; Surgical haemostats; Trifecta.

MeSH terms

  • Adult
  • Aged
  • Blood Loss, Surgical / prevention & control
  • Hemostasis, Surgical / methods*
  • Hemostatics / therapeutic use*
  • Humans
  • Length of Stay
  • Male
  • Margins of Excision
  • Middle Aged
  • Pilot Projects
  • Polysaccharides
  • Powders
  • Prostatectomy*
  • Robotic Surgical Procedures*

Substances

  • Hemostatics
  • Polysaccharides
  • Powders