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

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 (R) 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. Copyright (C) 2013 S. Karger AG, Basel