Radiographic Assessment of the Vesicourethral Anastomosis Directing Early Decatheterization Following Nerve-Sparing Radical Retropubic Prostatectomy

Abstract

Early decatheterization directed by postoperative gravity cystography in 55 consecutive radical prostatectomy patients is described. The catheter-free status was 22 per cent by postoperative day 8, 62 per cent by postoperative day 11 and 80 per cent by postoperative day 14. Cystograms performed beginning on postoperative day 7 identified 3 groups of patients and dictated their management: 1) no extravasation resulting in immediate catheter removal (36 patients), 2) moderate extravasation requiring repeat cystography leading to decatheterization by postoperative day 15 (9 patients) and 3) severe extravasation necessitating prolonged catheter drainage (8 patients). A decatheterization protocol is presented.

Anastomotic Stricture after Radical Prostatectomy

“…Later appearance of the stricture implies scar formation at the stricture site and dilatation has a lower success rate. An incidence of 9% acute urinary retention after decatheterization has been reported [7]. We observed this in 4 of 340 cases.…”

“…Stricture of the vesicourethral anastomosis is a well-known complication after radical prostatectomy with most cases becoming symptomatic within the first year after surgery. The mean interval between surgery and stricture formation was discovered to be 3.8 months [7]. Other authors observed 66% of the appearance of anastomotic strictures within 6 months after radical prostatectomy [2].…”

The Impact of Urinary Extravasation after Radical Retropubic Prostatectomy on Urinary Incontinence and Anastomotic Strictures

“…Despite agreement on surgical technique, there is no general consensus regarding the time of catheter removal [11,12,16]. Data of prospective, randomised clinical trials to clarify this issue are not available.…”

Suprapubic versus transurethral bladder drainage after radical prostatectomy: Impact on patient discomfort

“…It is reported that in patients undergoing abdominal, gynecological or vascular surgery, postoperative discomfort was significantly higher in patients with urethral versus suprapubic catheterization. [5][6][7] Although many studies have recently shown that cystography can direct early catheter removal with no increase in morbidity, 8,9 and there has been a movement towards shortened catheterization, 10,11 the optimal timing for catheter removal is yet to be determined.…”