ABSTRACT
The use of biologic adhesives and hemostatic agents in surgery dates back nearly a century when Bergel first described using dry plasma for hemostasis in 1909.1
Over the ensuing decades, fibrin patches, sealants, and glues became available as surgical adjuncts for operative hemostasis and/or tissue adhesion. However, due to concerns regarding viral disease transmission, the US Food and Drugs Administration (FDA) revoked the use of pooled human fibrinogen products in 1978. Not until 1998, with improved sterilization methods, did commercial fibrin compounds re-enter the US market. Within the past 50 years, topical gelatins, oxidized cellulose, microfibrillar collagen, glutaraldehyde compounds, recombinant human factor VII, and others have become available. Urologic surgeons have seen an explosive growth of effective biologic adhesives and hemostatics for open, endoscopic, and laparoscopic surgery. Nevertheless, we must be mindful that the use of these compounds for the most part remains ‘offlabel’ in urology. Moreover, these compounds have similar names yet different mechanisms of action with specific indications and contraindications. Thus, the reconstructive surgeon must have a clear understanding of each compound before using it in surgery.
