Shpetim Telegrafi

Optimizing the detection of subclinical inguinal hernias in men undergoing open radical retropubic prostatectomy

Study Type – Diagnostic (exploratory cohort)
Level of Evidence 2b

Transabdominal Sonocystography: A Novel Technique to Assess Vesicourethral Extravasation Following Radical Prostatectomy

PURPOSE We describe our new technique of transabdominal sonocystography in men following radical prostatectomy. MATERIALS AND METHODS From May 2007 to January 2008, 75 men underwent gravity transabdominal sonocystography and fluorocystography 8 days following open radical retropubic prostatectomy. Bladder volume after the instillation of 150 cc saline was determined by measuring bladder height, width and length in the longitudinal and transverse planes. Extravasation volume was calculated by subtracting the calculated bladder volume after filling from a volume of 165 ml, which represents the instilled saline volume of 150 ml plus 15 ml in the urinary catheter balloon. Extravasation was then qualitatively graded as none, slight, moderate or severe after instilling 150 cc contrast medium into the bladder. RESULTS The correlation between fluorocystography and transabdominal sonocystography was ascertained by determining the mean extravasation volume corresponding to the qualitatively graded categories of extravasation determined fluoroscopically. Mean extravasation volume in cases with no, slight and moderate extravasation on fluoroscopic cystography was -3.72, 6.51 and 46.0 ml, respectively. At an extravasation volume of 20 ml the sensitivity and specificity of transabdominal sonography to differentiate no or slight vs moderate or severe fluoroscopic extravasation was 100%. CONCLUSIONS The advantages of transabdominal sonocystography over fluorocystography are lower cost, lack of radiation exposure and the ability to perform the procedure at most urological outpatient facilities. Therefore, transabdominal sonocystography represents a good alternative to fluorocystography for assessing the integrity of the vesicourethral anastomosis following open radical retropubic prostatectomy.

Para-anastomotic haematoma volume predicts the presence of anastomotic extravasation after radical retropubic prostatectomy

Study Type – Therapy (case series)
 Level of Evidence 4

Outpatient Ultrasound Urethrogram for Assessment of Anterior Urethral Stricture: Early Experience

OBJECTIVE To describe the technique of ultrasound urethrogram (USUG) for the diagnosis of anterior urethral stricture performed in an ambulatory setting without any adjunctive imaging. MATERIALS AND METHODS Between September 2013 and September 2015, 35 consecutive adult men (>18 years old) presenting for anterior urethral reconstruction underwent outpatient USUG prior to definitive management. No alternative imaging test was performed. Lengths of the strictures as determined by outpatient USUG and via direct intraoperative measurements were compared by a paired t test. RESULTS Strictures were in the bulbar urethra in 24 men and in the penile urethra in 11 men. The differences between the outpatient USUG length measurements (mean = 1.86 cm) and the intraoperative stricture length measurements (mean = 2.02 cm) were not significantly different (P = .10). Additionally, the correlation coefficient between these length measurements was 0.84 (P < .001). CONCLUSION Preoperative USUG performed in the ambulatory setting for the diagnosis and characterization of anterior urethral strictures is safe and feasible. This outpatient imaging modality offers an alternative to retrograde urethrogram.

Comprehensive preoperative evaluation and repair of inguinal hernias at the time of open radical retropubic prostatectomy decreases risk of developing post‐prostatectomy hernia

Study Type – Therapy (case series)

Imaging in benign prostatic hyperplasia: what is new?

Purpose of reviewThis article discusses the new imaging techniques in diagnosis and treatment of benign prostatic hyperplasia by reviewing the most recent publications. Recent findingsImaging study for the evaluation of patients with lower urinary tract symptoms is not suggested by American Urology Association guidelines; however, European Association of Urology recommends the assessment of the upper urinary tract by modalities like ultrasound. Several new imaging indices like resistive index of capsular artery, presumed circle area ratio, prostatic urethral angle, intraprostatic protrusion, and detrusor wall thickness are used to find a noninvasive way for bladder outlet obstruction diagnosis. In addition to them, 3D transrectal ultrasound, near infrared spectroscopy, and MRI are used to add more practical findings in patient management. SummaryUrologists have requested more imaging studies than expected for benign prostatic hyperplasia patients in recent years, and several studies have been done to find a noninvasive way to diagnose bladder outlet obstruction. However, none of them could play the urodynamic studies role in bladder outlet obstruction diagnosis.

Transperineal Sonocystography New Standard for Assessing Anastomotic Leaks After Radical Prostatectomy

Objective. Fluorocystography (FC) is the reference standard for assessing the integrity of the vesicourethral anastomosis after radical prostatectomy (RP). We describe a new technique, transperineal sonocystography (TPSC), as a cost‐effective alternative and more informative than FC. Methods. Between May 1, 2007, and October 1, 2008, 175 consecutive men underwent open or robotically assisted RP. Before Foley catheter removal, all men underwent both TPSC and FC, which were performed and interpreted by a single radiologist. Transperineal sonocystography was performed first with real‐time imaging after gravity filling of the bladder with 150 mL of normal saline. Extravasation of saline was calculated by computer software after outlining the observed pooling of extravasated saline in the transverse and longitudinal views. Fluorocystography was performed after TPSC using our standard protocol, with qualitative classification of anastomotic leaks as none, slight, moderate, or severe. Results. The mean extravasation volume ± SEM was 16.3 ± 2.9 mL. Of the 175 patients, 142 (81.2%) showed no anastomotic leaks on TPSC. Of the remaining 33 patients (18.8%), TPSC identified 20 (11.4%), 13 (7.4%), and 0 patients with slight, moderate, and severe leaks, respectively. Excellent concordance was shown between TPSC and FC. Conclusions. Transperineal sonocystography was equivalent to FC in detecting anastomotic leaks after RP. It provides a safe, inexpensive, and effective alternative to traditional FC for evaluating the integrity of the vesicourethral anastomosis after RP.

MP15-11 OUTPATIENT ULTRASOUND URETHROGRAM FOR ASSESSMENT OF ANTERIOR URETHRAL STRICTURE RENDERS RADIATION EXPOSURE UNNECESSARY

INTRODUCTION AND OBJECTIVES: Knowledge of urethral stricture anatomy is essential for appropriate surgical management. While retrograde urethrogram is considered the gold standard for evaluation, ultrasound urethrogram has been shown to be more accurate in determining anterior urethral stricture length and extent of spongiofibrosis. To date, ultrasound urethrograms have been primarily performed intra-operatively. We report the results of an outpatient ultrasound urethrogram technique, which eliminates the need for radiation exposure. METHODS: Twelve consecutive adult men presenting for anterior urethral reconstruction from 10/2013-10/2014 underwent outpatient ultrasound urethrogram. Patients were excluded from this study if any urethral imaging has been performed using radiation (retrograde urethrogram or voiding cystourethrogram). The Siemens Acuson S2000 Ultrasound System is used at our institution. Outpatient retrograde ultrasound urethrogram is performed with the patient in the frog-leg position. Lidocaine gel is injected through the meatus to distend the urethra and act as contrast. Linear High-frequency multi-hertz 18L6 and curved multi-hertz 6C2 probes are used to study the penile and bulbar urethra, respectively. Lengths of strictures as determined by outpatient ultrasound urethrogram and direct intra-operative measurements were analyzed by a paired t-test. RESULTS: Table 1 shows the differences between ultrasound urethrogram and intra-operative stricture lengths. The difference between ultrasound urethrogram stricture length measurement (mean1⁄41.7833, standard deviation1⁄40.8892) and intra-operative stricture length measurement (mean1⁄41.7500, standard deviation1⁄41.011) was not significant with t(11)1⁄40.358, p1⁄40.727. Further, the correlation coefficient between the two length measurements is 0.950 (p<0.001). CONCLUSIONS: Our technique of outpatient ultrasound urethrogram for the diagnosis and characterization of anterior urethral strictures is simple, accurate, and eliminates the need for radiation exposure for evaluation of anterior urethral strictures.