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Detection of urinary leakage after radical retropubic prostatectomy by contrast enhanced ultrasound – do we still need conventional retrograde cystography?
Author(s) -
Schoeppler Gita M.,
Buchner Alexander,
Zaak Dirk,
Khoder Wael,
Staehler Michael,
Stief Christian G.,
Reiser Maximilian F.,
Clevert DirkAndre
Publication year - 2010
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2010.09497.x
Subject(s) - medicine , cystography , anastomosis , ultrasound , prostatectomy , contrast enhanced ultrasound , urinary leakage , radiology , urology , radical retropubic prostatectomy , nuclear medicine , urinary system , surgery , prostate cancer , urinary incontinence , cancer
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.