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MDCT Cystography for Detection of Vesicourethral Leak After Prostatectomy

¹ Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
² Department of Radiology, Clinical Research Institute, Seoul National University Hospital and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
³ Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
⁴ Department of Radiology, Konkuk University Hospital, Seoul, Republic of Korea.
⁵ Department of Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea.

OBJECTIVE. The purpose of this study was to compare detection rates with MDCT cystography and conventional cystography in the evaluation of vesicourethral leakage after radical prostatectomy.

SUBJECTS AND METHODS. From September 2004 to May 2005, 51 sets of MDCT and conventional cystographic images of 46 patients who underwent retropubic radical prostatectomy were included in the study. The mean age of the patients was 65.3 ± 2.1 years. The rates of detection of vesicourethral leakage at the anastomotic site were compared on conventional and MDCT cystographic images. In cases in which leakage was detected at MDCT cystography, the amount of contrast medium leaked was calculated with 3D volumetry. Correlation between leakage volume and hospital stay or indwelling time of a Foley catheter also was evaluated.

RESULTS. The rate of detection of vesicourethral leakage determined with MDCT cystography was 80.4% (37 of 46 cases), and that determined with conventional cystography was 54.3% (25 of 46 cases). The mean volume of leakage detected only with MDCT cystography was 2.2 ± 2.1 mL, and that with both conventional and MDCT cystography was 19.3 ± 14.1 mL. There was a moderate positive correlation between Foley catheter indwelling time and leakage volume.

CONCLUSION. MDCT cystography can be used for evaluation of leaks at the anastomotic site after prostatectomy and may have a better leak detection rate than conventional cystography.

Keywords: cystography • MDCT • prostate cancer • radical prostatectomy • vesicourethral leak

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