Comparison of BioGlue reinforced and standard running sutured vesicourethral anastomoses

To compare a BioGlue-reinforced laparoscopically sutured vesicourethral anastomosis (VUA) with a standard laparoscopically sutured VUA in a porcine model.

Twelve pigs were divided into two groups. In group 1 (n = 6), a standard laparoscopically sutured VUA was performed. In group 2 (n = 6), a standard laparoscopic sutured VUA was performed, and the anastomosis was reinforced with BioGlue. Groups 1 and 2 were completed consecutively. The animals in both groups were killed at 1 week postoperatively. In all cases, cystography was performed immediately after completion of the anastomosis and at death. At necropsy, the gross findings of the VUA were documented, and each anastomosis was excised en bloc for an extensive histopathologic evaluation of the healing parameters, including inflammation and fibrosis at each tissue level, foreign body reactions, and necrosis.

Of the 12 VUAs, 11 were successfully performed laparoscopically. The median operative time for groups 1 and 2 was 70 and 100 minutes, respectively (P = 0.03). The median anastomotic time for groups 1 and 2 was 30 and 50 minutes, respectively (P = 0.02). No difference was seen in urinary extravasation on the cystographic evaluation in the immediate postoperative or 1-week evaluations. At necropsy, a gross complete circumferential histologic tissue approximation was noted in 1 (20%) of 5 pigs in group 1 and 2 (33%) of 6 pigs in group 2 (P = 0.66). No urinomas were noted in either group. Histopathologic evaluation revealed no significant difference between groups 1 and 2 regarding inflammation, fibrosis, foreign body reactions, or necrosis.

The application of BioGlue to the anastomotic line extended the procedure time and did not improve the quality of the VUA.