Comparative trial assessing suture techniques and types of urinary catheters in vesicourethral anastomotic tensile strength in a porcine model

Perera, Marlon, Divakaran, Pranav, Roberts, Matthew J. and Chung, Eric (2017) Comparative trial assessing suture techniques and types of urinary catheters in vesicourethral anastomotic tensile strength in a porcine model. Journal of the Mechanical Behavior of Biomedical Materials, 65 408-414. doi:10.1016/j.jmbbm.2016.09.005

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Author Perera, Marlon
Divakaran, Pranav
Roberts, Matthew J.
Chung, Eric
Title Comparative trial assessing suture techniques and types of urinary catheters in vesicourethral anastomotic tensile strength in a porcine model
Journal name Journal of the Mechanical Behavior of Biomedical Materials   Check publisher's open access policy
ISSN 1878-0180
1751-6161
Publication date 2017-01-01
Sub-type Article (original research)
DOI 10.1016/j.jmbbm.2016.09.005
Open Access Status Not yet assessed
Volume 65
Start page 408
End page 414
Total pages 7
Place of publication Amsterdam, Netherlands
Publisher Elsevier BV
Language eng
Subject 2502 Biomaterials
2204 Biomedical Engineering
2211 Mechanics of Materials
Abstract Purpose Vesicourethal anastomosis (VUA) during radical prostatectomy can be achieved using various suture plication techniques. Traditionally, an indwelling urinary catheter remains in-situ to facilitate the healing process of the reconstructed VUA. Compromise or rupture of this anastomosis may lead to acute urinary leak and subsequent urinoma or stricture formation. This ex-vivo porcine model aims to evaluate VUA tensile strength using different suture techniques and catheter types. Methods Male porcine bladders were obtained and prostatectomy was performed. The specimens were randomized and VUA were created using 3-point interrupted, 6-point interrupted or 6 point continuous 3-0 monocryl suture. 20Fr catheters were utilized, specifically varying manufacturers (A and B) and catheter balloon shapes (round versus oval). The VUA model was placed within a reproducible pulley system and graduated weights were applied until failure of the catheter balloon or the model VUA. Model failure was defined as either ‘VUA rupture’, ‘Catheter passage through VUA’ or ‘catheter failure’. Results Twenty consecutive porcine bladders were prepared, tested and utilized for analysis. VUA reconstructed with 3-point fixation was more likely to suffer VUA rupture (p=0.025) compared to 6-point interrupted or 6-point continuous VUA. Higher tensile pressure causing catheter balloon rupture (p=0.009) was observed for Manufacturer A. Catheters with oval-balloon shape were more likely to dislodge past the VUA without disruption of the anastomosis (p=0.002). Conclusions During prostatectomy, anastomotic technique and catheter selection can significantly alter the tensile properties of the VUA. Further research is required to validate our findings in clinical models.
Formatted abstract
Purpose: Vesicourethal anastomosis (VUA) during radical prostatectomy can be achieved using various suture plication techniques. Traditionally, an indwelling urinary catheter remains in-situ to facilitate the healing process of the reconstructed VUA. Compromise or rupture of this anastomosis may lead to acute urinary leak and subsequent urinoma or stricture formation. This ex-vivo porcine model aims to evaluate VUA tensile strength using different suture techniques and catheter types.

Methods: Male porcine bladders were obtained and prostatectomy was performed. The specimens were randomized and VUA were created using 3-point interrupted, 6-point interrupted or 6 point continuous 3-0 monocryl suture. 20Fr catheters were utilized, specifically varying manufacturers (A and B) and catheter balloon shapes (round versus oval). The VUA model was placed within a reproducible pulley system and graduated weights were applied until failure of the catheter balloon or the model VUA. Model failure was defined as either ‘VUA rupture’, ‘Catheter passage through VUA’ or ‘catheter failure’.

Results: Twenty consecutive porcine bladders were prepared, tested and utilized for analysis. VUA reconstructed with 3-point fixation was more likely to suffer VUA rupture (p=0.025) compared to 6-point interrupted or 6-point continuous VUA. Higher tensile pressure causing catheter balloon rupture (p=0.009) was observed for Manufacturer A. Catheters with oval-balloon shape were more likely to dislodge past the VUA without disruption of the anastomosis (p=0.002).

Conclusions: During prostatectomy, anastomotic technique and catheter selection can significantly alter the tensile properties of the VUA. Further research is required to validate our findings in clinical models.
Keyword Anastomosis
Catheters
Prostate cancer
Prostatectomy
Tensile strength
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

 
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