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Postoperative Anastomosenkontrolle nach radikaler retropubischer Prostatektomie

Kann der transrektale Ultraschall die Zystographie ersetzen?

Postoperative monitoring of anastomosis after radical retropubic prostatectomy

Transrectal ultrasound can replace cystography?

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Zusammenfassung

Hintergrund

Es wurde untersucht, ob Anastomoseninsuffizienzen nach radikaler retropubischer Prostatektomie (RRP) genauso sicher durch eine transrektale Ultraschalluntersuchung identifiziert werden können, wie durch eine Zystographie.

Material und Methoden

Von Oktober 2005 bis Februar 2006 wurden prospektiv 100 radikal prostatektomierte Patienten untersucht. Am 6. postoperativen Tag (POD) nach RRP wurde die vesikourethrale Anastomose in einer kombinierten Untersuchung aus transrektalem Ultraschall (TRUS) und einer Zystographie untersucht.

Ergebnisse

Bei der Mehrheit der Patienten (79%) war die Anastomose am 6. postoperativen Tag (POD) wasserdicht oder zeigte minimale Leckagen (8%), die eine Katheterentfernung zuließen. Insgesamt wurden 21 Paravasate diagnostiziert, welche unterschiedliche Schweregrade aufwiesen. Aufgrund kleiner (n=5), mäßiger (n=3) bzw. ausgeprägter Paravasate (n=5) wurde der Katheter am 9., 14. bzw. 21. POD entfernt. Bezüglich der Paravasatdetektion war die Sensitivität des TRUS und der Zystographie identisch. Per TRUS wurden 2 falsch-positive Befunde erhoben.

Schlussfolgerung

Die Anastomosenkontrolle nach radikaler Prostatektomie kann aufgrund gleicher Sensitivität mittels TRUS statt einer Zystographie durchgeführt werden.

Abstract

Objective

We determined if transrectal ultrasound (TRUS) is as reliable as cystography in detecting vesicourethral extravasates after radical retropubic prostatectomy (RRP).

Patients and methods

Between October 2005 and February 2006 we prospectively investigated 100 consecutive patients undergoing RRP. The vesicourethral anastomosis was proven 6 days after operation by a combined investigation with TRUS and cystography.

Results

In the majority of patients (79%) the vesicourethral anastomosis was watertight on postoperative day 6 (POD) or showed minimal leakage (8%) so that the urinary catheter was removed. Different degrees of paravasates were detected in 21 patients. Because of small, moderate, or marked paravasations the indwelling catheter was removed on POD 9, 14, and 21 in 5, 3, and 5 patients, respectively. Every paravasate documented by cystography had been detected by TRUS before. Therefore, TRUS showed no false-negative result in detecting insufficient anastomosis. In two patients paraurethral fluid was detected by TRUS mimicking anastomotic paravasation, without confirmation by cystography.

Conclusions

TRUS can safely replace cystography to detect anastomotic leakage after radical prostatectomy.

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Authors and Affiliations

  1. Urologische Klinik, Marienhospital Herne, Ruhr-Universität Bochum, Widumer Straße 8, 44627, Herne, Deutschland

    T. Eggert, J. Palisaar, P. Metz & J. Noldus

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  1. T. Eggert
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  2. J. Palisaar
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  3. P. Metz
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  4. J. Noldus
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Correspondence to T. Eggert.

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Eggert, T., Palisaar, J., Metz, P. et al. Postoperative Anastomosenkontrolle nach radikaler retropubischer Prostatektomie. Urologe 46, 1112–1117 (2007). https://doi.org/10.1007/s00120-007-1442-2

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  • DOI: https://doi.org/10.1007/s00120-007-1442-2

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