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

INTRODUCTION

After radical prostatectomy, many institutions perform cystography to exclude vesicourethral anastomotic leakage before removing a urethral catheter. We reviewed diagnostic methods to exclude leakage compared to the reference standard cystography.

METHODS

We performed systematic literature review to summarize the published options and outcomes for assessment of vesicourethral anastomotic leakage after radical prostatectomy.

RESULTS

Of 2,137 publications, 45 full-text manuscripts underwent full-text screening, of which 9 studies contributing 919 patients were included. Seven studies described ultrasound-guided assessment (four transrectal, two transabdominal, one transperineal). Two further studies described the use of computerized tomography. Ultrasound-guided assessment of the anastomosis after radical prostatectomy shows promising agreement with cystography. Computerized tomography-aided assessment of vesicourethral anastomosis detects more leakages; however, clinical consequences are not defined.

CONCLUSION

Further studies are warranted to (1) identify men at risk of anastomotic leakage who should undergo assessment before trial without a catheter and (2) provide prospective comparisons of different ultrasound-guided approaches.