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. (C) 2022 S. Karger AG, Basel

Automated summary

This article reviewed diagnostic methods to exclude leakage after radical prostatectomy and compared them with cystography. The results showed that ultrasound-guided assessment had promising agreement with cystography, while computerized tomography could detect more leakages, although the clinical consequences were not defined. Further studies are needed to identify patients at risk of leakage and to provide prospective comparisons of different ultrasound-guided approaches.