Assessing the vesico‐urethral anastomosis after radical retropubic prostatectomy: transrectal ultrasonography can replace cystography

Abstract

OBJECTIVE To determine if transrectal ultrasonography (TRUS) is as reliable as cystography in detecting vesico‐urethral extravasation (VE) after radical retropubic prostatectomy (RRP). PATIENTS AND METHODS Between October 2005 and February 2006 we prospectively investigated 100 consecutive patients undergoing RRP. The vesico‐urethral anastomosis was assessed 6 days after RRP by a combined investigation with TRUS and cystography. RESULTS In most patients (79%), at 6 days after RRP the vesico‐urethral anastomosis was watertight or showed minimal leakage (8%), so that the urinary catheter was removed. Different degrees of VE were detected in 21 patients. Because of small, moderate or marked VE, the indwelling catheter remained until 9, 14 and 21 days after RRP in five, three and five patients, respectively. Every VE documented by cystography was detected by TRUS beforehand; therefore TRUS showed no false‐negative results in detecting a leaking anastomosis. In two patients paraurethral fluid was detected by TRUS mimicking VE, with no confirmation by cystography. CONCLUSIONS TRUS can safely replace cystography for detecting anastomotic leakage after RRP. The decision to remove the catheter after RRP can be made without radiation exposure and use of expensive contrast medium.

Unidirectional barbed suture versus standard monofilament for urethrovesical anastomosis during robotic assisted laparoscopic radical prostatectomy

“…However, this small difference would most likely be clinically insignificant given our relative low percentage of leak. Studies have shown that a majority (79 to 95%) of patients undergoing radical prostatectomy do not have a urine leak by cystogram seven days postoperatively (13)(14)(15). By 15 to 21 days after surgery, nearly 100% of patients do not have a urinary leak at the UVA (13,16).…”

“…Studies have shown that a majority (79 to 95%) of patients undergoing radical prostatectomy do not have a urine leak by cystogram seven days postoperatively (13)(14)(15). By 15 to 21 days after surgery, nearly 100% of patients do not have a urinary leak at the UVA (13,16). The type or number of sutures used has not seemed to affect urinary leak rates, suggesting that the most important factor in a leak-free UVA is good tissue approximation and an intraoperative watertight closure.…”

Transrectal Contrast-Enhanced Ultrasonography, Transrectal Ultrasonography and Retrograde Cystography for the Detection of Vesicourethral Anastomosis Leakage after Radical Retropubic Prostatectomy: A Prospective Comparative Evaluation

“…Eggert et al [10] reported a sensitivity of 100% and specificity of 97.5% using a TRUS for assessing the urinary leakage at the VUA site on postoperative day 6 in a series of 100 men undergoing RRP. Schenck and Schneider [11] developed a new method for evaluating the VUA using a dynamic TRUS with bladder filled only with NaCl 0.9% on postoperative days 4-8.…”

“…In recent years, ultrasound has emerged as an interesting alternative diagnostic tool for evaluating the urinary leakage at the VUA site. It could be performed by the urologist and easily repeated, there is no exposure to radiation, it is useful for the evaluation of any hematomas or lymphoceles and it has low costs [10]. …”

“…Transrectal ultrasonography (TRUS) has been proposed as an alternative tool for detecting urinary leakage at the site of VUA and it can be performed directly by the urologist in the office with no need for transferring the patient to a radiology suite [10,11]. More recently, transrectal contrast-enhanced ultrasonography (CEUS) has been shown to be another reliable tool in this setting by offering a similar performance to CG [12].…”