Sonographic Characteristics of the Urethrovesical Anastomosis in the Early Post-Radical Prostatectomy Patient

Abstract

It is possible that the advent of more aggressive surgical approaches to carcinoma of the prostate, including neoadjuvant and adjuvant therapy, will lead to a higher incidence of pelvic recurrence rates in coming years. A method of sequentially monitoring the region of the urethrovesical anastomosis for early recurrence that is more accurate than digital rectal examination is required. Transrectal ultrasound is an established technique for the preoperative assessment of prostate cancer. It has also been used postoperatively to guide a biopsy needle into palpably suspicious areas at the urethrovesical junction or for random biopsies in patients with elevated prostate specific antigen levels. However, the sonographic anatomy of the postoperative urethrovesical junction has not previously been described. In this prospective study we analyze the transrectal sonographic characteristics of the neoanatomy in 30 patients, all within 3 months following surgery for clinically intracapsular disease. We describe features of the neoanatomy, such as anterior tissue nodules and anastomotic rings. Because of distinct variations in the neoanatomy of different patients we recommend early postoperative transrectal biplanar sonography to establish a baseline image for each individual case. This would be useful for later comparison and may prevent a false positive scan on subsequent followup studies.