Transrectal ultrasonography can safely replace cystography in assessing vesico-urethral anastomosis after radical prostatectomy

Objectives: A well performed vesico-urethral anastomosis (VUA) allows an early catheter removal and cystography is mandatory to exclude urinary extravasation. Aim of the study is to investigate whether transrectal ultrasonography (TRUS) is as reliable as cystography in detecting anastomotic leakage after radical retropubic prostatectomy (RRP) in order to avoid the use of X-rays. Methods: 50 patients (pts) underwent RRP. VUA integrity was assessed 7 days after surgery by cystography and subsequently by TRUS to assess the patency of VUA. Patients who showed extravasation at the cystogram underwent ultrasonography in order to evaluate the leakage shown with cystography. Results: Catheter was removed after 7 days in all patiens except 2 pts (4%) showed extravasation at the cystography that was exactly detected at the TRUS investigation, therefore the catheter was maintained for another week. TRUS investigation, performed after cystography, also revealed the presence of a lymphocele and a retropubic hematoma, in two different patients, both completely asymptomatic and misdiagnosed at the cystography. Conclusions: Urinary leakage in the first days after RRP can be frequent and cystography is mandatory to assess VUA integrity, when early catheter removal is planned. TRUS as an alternative investigation technique to cystography, showed a high sensitivity and specificity in detecting extravasation and was also able to diagnose complications related to RRP that cystography didn't show.