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

Abstract

Objectives: To evaluate the diagnostic accuracy of cystography (CG), transrectal ultrasonography (TRUS) and transrectal contrast-enhanced ultrasonography (CEUS) for the detection of vesicourethral extravasation (VE) after radical retropubic prostatectomy (RRP). Patients and Methods: In 80 consecutive patients who underwent RRP, the strength of the vesicourethral anastomosis (VUA) was assessed by CG, TRUS and transrectal CEUS. The investigation started with a conventional CG evaluated by an experienced uroradiologist. Following this, patients underwent TRUS which was performed by an experienced urologist who was blinded to the CG findings. The examination started with a conventional B-scan and, subsequently, a CEUS was performed by emptying and refilling the bladder with 90 ml of NaCl 0.9% + 10 ml suspension of 1:10 SonoVue and NaCl 0.9%. Results: 26 patients (32.5%) presented urinary VE and 54 (67.5%) a watertight VUA. In 16 patients (61%) we observed a small leakage, 9 patients (35%) presented a moderate VE, and a large VE was detected in 1 patient (4%). No statistically significant difference in detection of VE was found among the three tests (p = 0.472). Conclusions: TRUS and CEUS are able to provide information about the integrity of the VUA that is comparable with that of CG.

Assessment of the Anastomosis after Radical Prostatectomy: A Review of Available Diagnostic Methods

“…In another study without an ultrasound contrast agent, Eggert et al [3] also reported good agreement between the transrectal ultrasound and cystography in a cohort of 100 men (21 leakages detected using cystography and 23 leakages detected using the transrectal ultrasound). Further, Cantiello et al [4] used an ultrasound contrast agent and reported detection rates very similar to cystography rates for anastomotic leakage using transrectal ultrasound. In this study of 80 men, 26 anastomotic leaks were detected by cystography, of which 24 were detected by transrectal ultrasound without contrast and 25 by transrectal ultrasound using a contrast.…”

“…Seven articles compared cystography using pelvic Xrays versus ultrasound-guided assessment, and two compared cystography with computerized tomography (CT; Table 1). For ultrasound-guided assessments, three transducer locations, including transrectal (n = 4, [2][3][4][5]), transabdominal (n = 2, [6,7]), and transperineal (n = 1, [8]) positions were used, and saline was applied through the transurethral catheter with or without an ultrasound contrast agent.…”

Classification urine leakage from urethrovesical anastomosis after prostatectomy

“…и M. Schenck и соавт. не выявили статистически значимой разницы между динамическим трансректальным ультразвуковым исследованием и ретроградной цистографией для оценки несостоятельности УВА [3,4]. В проспективном исследовании O.K.…”

A Robotic Needle Driver to Facilitate Vescico-Urethral Anastomosis during Laparoscopic Radical Prostatectomy

“…All patients underwent an ultrasound control of the anastomosis on the seventh postoperative day, as we usually do (9, 10).…”