Dynamische transrektale Ultraschalluntersuchung (dTRUS): Eine neue Methode zur Beurteilung der Anastomoseninsuffizienz nach radikaler Prostatektomie (RRP)

Schenck, M.; Jaeger, Tim M.; Boergermann, Christof; Ruebben, Herbert

doi:10.1055/s-2006-927303

Ultraschall in Med

2007

DOI: 10.1055/s-2006-927303

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Dynamische transrektale Ultraschalluntersuchung (dTRUS): Eine neue Methode zur Beurteilung der Anastomoseninsuffizienz nach radikaler Prostatektomie (RRP)

M. Schenck

Tim M. Jaeger²,

Christof Boergermann³

et al.

Abstract: Dynamic transrectal ultrasound is a reliable and reasonable method to identify extravasation after RRP. Furthermore radiation exposure (on average 60 cGy/cm(2)/cystoradiogram) can be avoided by replacing the cystoradiogram with dTRUS slips with the dTRUS.

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Einfache und effektive Beurteilung der Anastomose nach radikaler retropubischer Prostatektomie

Schenck

Schneider

2010

Urologe

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After radical prostatectomy, urinary extravasation at the anastomosis is common. Nevertheless, no data exist regarding the optimal time for catheter removal at the time of expected complete healing of the leakage. Therefore, over the last 10 years we have developed a standardized way to check the healing of the anastomosis. From 1999 to 2008, 1,479 radical prostatectomies were performed. Of those, 752 could be evaluated using the standardized method of checking the anastomosis for complete healing. All patients were postoperatively evaluated by cystogram. The date for checking the anastomosis/extravasation was determined by the color of the urine (cloudy, clear, or bloody). In the 752 evaluated patients (mean age 64 years), urinary extravasation was detected 2-8 days postoperatively in 41%, 9-12 days postoperatively in 16%, and in no patient 21 days postoperatively. The measured volume of urinary extravasation after 2-8 days postoperatively was 15 ml (3-49 ml) using cystogram evaluation. After 9-12 days, the volume was determined by cystogram to be 9 ml (3-24 ml). Macroscopic evaluation of the urinary color correlated very well with the likelihood of extravasation still being present. When the urine was cloudy or colored by old blood, extravasation was present in 86% of the patients (predictive value 0.99, specificity 97%). Microscopic evaluation of the urine on the same day showed that significant leukocyturia or hematuria correlated with persistent extravasation in 49% of the patients (sensitivity 98%, specificity 34%). The transurethral catheter remained in place for a mean of 7.9 days (4-31 days). After radical prostatectomy, the macroscopic color of the urine is evaluated as a single criterion for determining the time for assessing for possible persisting leakage of the anastomosis. Microscopic urine evaluation is less effective.

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Einfache und effektive Beurteilung der Anastomose nach radikaler retropubischer Prostatektomie

Schenck

Schneider

2010

Urologe

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New standardization of checking the vesicourethral anastomosis for tightness following radical prostatectomy with dynamic transrectal ultrasound: can this new technique replace the traditional postoperative cystogram?

Schenck

Schneider

2011

World J Urol

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Detection of urinary leakage after radical retropubic prostatectomy by contrast enhanced ultrasound – do we still need conventional retrograde cystography?

Schoeppler

Büchner²,

Zaak³

et al. 2010

BJU International

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Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b INTRODUCTION To prospectively evaluate the accuracy of transvesical contrast‐enhanced ultrasound (CEUS) as an alternative method for the detection of anastomotic leakage after radical retropubic prostatectomy (RRP) in comparison with the current standard method of conventional retrograde cystography (CG). PATIENTS AND METHODS Forty‐three patients underwent RRP for histologically proven localized prostate cancer. The vesico‐urethral anastomosis was evaluated 8 days after RRP by CG and CEUS. Any peri‐anastomotic leakage was assessed and determined in CG and CEUS as follows: no extravasation (EV), small leakage (≤0.5 cm), moderate leakage (>0.5 cm to ≤2 cm), large leakage (>2 cm diameter of EV seen). RESULTS In total, 21 (49%) patients showed a watertight anastomosis. Ten (23%), two (4.7%) and ten (23%) patients showed a small, intermediate and large EV, respectively. In 31 cases (72%) there was 100% agreement of CG and CEUS for detection of no, moderate and large EV, respectively. In nine cases a small and in two cases a moderate EV was categorized as watertight anastomosis by CEUS. Only in one case did CG detect a small EV where a large EV was detected in CEUS. The agreement between both methods was 95% for detecting absence or large leakages. CONCLUSION CEUS is a promising imaging modality that seems to be equivalent to CG for detecting the presence of a large anastomotic leakage that is clinically relevant for postoperative persistence of the indwelling catheter. CEUS could be a cheap and time‐saving alternative to the CG without exposure of the patient to radiation.

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Dynamische transrektale Ultraschalluntersuchung (dTRUS): Eine neue Methode zur Beurteilung der Anastomoseninsuffizienz nach radikaler Prostatektomie (RRP)

Abstract: Dynamic transrectal ultrasound is a reliable and reasonable method to identify extravasation after RRP. Furthermore radiation exposure (on average 60 cGy/cm(2)/cystoradiogram) can be avoided by replacing the cystoradiogram with dTRUS slips with the dTRUS.

Cited by 3 publications

References 9 publications

Einfache und effektive Beurteilung der Anastomose nach radikaler retropubischer Prostatektomie

Einfache und effektive Beurteilung der Anastomose nach radikaler retropubischer Prostatektomie

New standardization of checking the vesicourethral anastomosis for tightness following radical prostatectomy with dynamic transrectal ultrasound: can this new technique replace the traditional postoperative cystogram?

Detection of urinary leakage after radical retropubic prostatectomy by contrast enhanced ultrasound – do we still need conventional retrograde cystography?

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