When and how should we test the tightness of the vesicourethral anastomosis after retropubic radical prostatectomy?

OBJECTIVE: To determine when the vesicourethral anastomosis (VUA) becomes tight after retropubic radical prostatectomy (RRP) and if an additional lateral view cystography provides significantly more information than the only anterior-posterior view. PATIENTS AND METHODS: Pressure-controlled cystography with anterior-posterior and lateral views was performed on postoperative days (POD) 3, 6 and 9 and evaluated in 100 consecutive patients after RRP. RESULTS: On POD 3, 6 and 9, 82, 80 and 82% of all VUA, respectively, were tight. 85% of all tight VUA on POD 3 remained tight on POD 6 and 9. Of the 52 extravasations in a total of 300 cystographies, 65% were recognizable in the anterior-posterior as well as in the lateral view cystography, 6% were seen only in the anterior-posterior view and 29% only in the lateral view. CONCLUSIONS: The VUA after RRP is tight in about 80% of the cases on POD 3, 6 and 9. A tight VUA on POD 3 does not exclude later extravasation on POD 6 and 9 (14%). About one third (29%) of all extravasations of VUA are seen only in the lateral view cystography after RRP.