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MDCT Cystography for Detection of Vesicourethral Leak After Prostatectomy

Hak Jong Lee1,2, Cheong-Il Shin3, Sung Il Hwang1,2, Sung Il Jung4, Seung Hyup Kim3, Sang Eun Lee5 and Seok-Soo Byun5

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.


Figure 1
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  		Fig. 1A —68-year-old man with large amount of vesicourethral leakage. Conventional cystogram shows leakage of contrast medium (arrows) around anastomotic site.

 

Figure 2
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  		Fig. 1B —68-year-old man with large amount of vesicourethral leakage. MDCT cystogram shows leakage of contrast medium. Pinpoint defect (arrowhead) is present at 6-o'clock position.

 

Figure 3
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  		Fig. 2A —71-year-old man with false-negative findings at conventional cystography. Conventional cystogram shows no definite evidence of leakage at vesicourethral anastomosis.

 

Figure 4
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  		Fig. 2B —71-year-old man with false-negative findings at conventional cystography. MDCT cystogram shows small amount of leakage (arrows) at anastomotic site.

 

Figure 5
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  		Fig. 3A —58-year-old man with well-marginated fistula track at MDCT cystography. Conventional cystogram shows leakage (arrows) at anastomotic site. Leakage site is uncertain.

 

Figure 6
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  		Fig. 3B —58-year-old man with well-marginated fistula track at MDCT cystography. MDCT cystogram shows small defect (arrow) at 7-o'clock position of anastomotic site.

 

Figure 7
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  		Fig. 3C —58-year-old man with well-marginated fistula track at MDCT cystography. Surface-shaded display of MDCT cystogram shows fistulous track (arrow) at vesicourethral anastomosis.

 

Figure 8
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  		Fig. 4 —Graph shows correlation between leakage volume and Foley catheter indwelling time. Statistical analysis revealed moderate positive correlation.

 

Figure 9
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  		Fig. 5 —70-year-old man with incidental finding of lymphocele at MDCT. CT scan shows well-marginated lesion with fluid attenuation adjacent to pelvic wall, suggesting lymphocele. Surgical clips (arrow) probably are for lymph node dissection.

 

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