Does topical hemostatic agent (Floseal(®)) have a long-term adverse effect on erectile function recovery after nerve-sparing robot-assisted radical prostatectomy? Beyond the Abstract

The local haemostatic agents are widely used in surgery, and especially in laparoscopy, to facilitate hemostasis, to promote the sealing of tissues and to support the hemostatic suture when traditional mechanical and thermal methods are ineffective, insufficient or not practicable.

Different studies evaluated the role of hemostatic agents as cause of noteworthy histopathological alterations such as inflammation, fibrosis and vascularity.  These induced histopathological changes could result in a functional damage when the hemostatic materials are applied on peripheral nerve structures such as neurovascular bundles.

In this work we provide a direct monocentric comparison between a group of patients that underwent an intra-fascial robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer and achieved hemostasis only by using traditional techniques and another similar group where Floseal was also adopted.

Long-term results in terms of erectile function recovery (EFR) at 6,9 and 12 months after the operation evaluated with the International Index of Erectile Function (IIEF) score showed a significant inverse correlation between EFR and Floseal application. We therefore believe that the use of Floseal to improve hemostatic outcome of RALP can be related to a lower recovery of erectile function and that its use should be carefully evaluated in sexually active patients.

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Written By: Giacomo Maria Pirola