Voiding cystourethrography after radical prostatectomy: normal findings and correlation between contrast extravasation and anastomotic strictures.

Abstract

Vesicourethral anastomotic strictures are an important complication of radical prostatectomy for prostatic cancer. Their formation has been attributed to extravasation of urine at the anastomosis and to the surgical technique used to construct the anastomosis. Our study examines whether the formation of a vesicourethral anastomotic stricture correlates with (a) contrast extravasation seen on postoperative voiding cystourethrograms and (b) the surgical technique used to construct the vesicourethral anastomosis. We also describe the postoperative appearances of the anastomosis. One hundred and forty-two patients who underwent radical retropubic prostatectomy at our institution between June 1, 1987, and December 31, 1991, were included in the study. Of these, 101 had a direct end-to-end vesicourethral anastomosis, and 41 had their anastomosis constructed with traction sutures (Vest procedure). Voiding cystourethrograms were obtained 3 weeks after the prostatectomy. The appearance of the anastomosis, the presence of extravasation of contrast material at the anastomotic site, and the relationship of the subsequent formation of an anastomotic stricture to extravasation were evaluated. The influence of the surgical technique used to construct the vesicourethral anastomosis on the development of anastomotic strictures was analyzed. Contrast extravasation at the anastomotic site was seen in 14 (14%) of 101 patients who had a direct procedure and in three (7%) of 41 patients who had a Vest procedure. No relationship was found between contrast extravasation and subsequent formation of a stricture. Anastomotic strictures occurred in 16 (16%) of 101 patients who had a direct anastomosis and in 12 (29%) of 41 patients who had a Vest procedure. The surgical technique used to construct the vesicourethral anastomosis influenced the appearance of the vesicourethral anastomosis on cystourethrograms. Contrast extravasation at the anastomotic site is not infrequently seen on voiding cystourethrograms obtained after radical retropubic prostatectomy and resolves with continued drainage via a Foley catheter. As long as catheters are left in place until anastomotic healing is complete, extravasation of contrast material (implying urine extravasation at the anastomotic site) does not influence the subsequent formation of anastomotic strictures. Anastomoses that heal more slowly are no more likely to develop strictures than normally healing ones. Construction of the vesicourethral anastomosis by using the Vest procedure is a significant risk factor for stricture formation.