[Transrectal ultrasonography in the assessment of patients after radical prostatectomy. Normal and pathologic ultrasonography anatomy of vesico-urethral anastomosis].
OBJECTIVE
To determine the ultrasound characteristics of the vesico-urethral anastomotic complex in patients with radical prostatectomy to separate normal prostate fossae from those affected by local recurrence or residual tumour.


METHODS
Between January 1998 and June 1999 15 ultrasound guided transrectal biopsies of vesico-urethral anastomosis or prostate fossae were performed in patients with radical prostatectomy. The selection criteria to perform puncture in these patients were a negative extension study (abdominal-pelvic CT and bone scan), PSA higher than 0.4 ng/mL and/or suspicious DRE. The study was completed with 10 transrectal ultrasound (TRU) after radical prostatectomy in patients with normal PSA and DRE. TRU parameters in patients with tumour-positive biopsies were compare to those from patients with negative biopsies and those obtained from TRU in patients with both normal PSA and normal DRE.


RESULTS
The ultrasound parameters that best described prostate fossa abnormalities were the presence of hypoechoic masses or nodes and the integrity or not of the retro-anastomotic fat layer. When a hypoechoic mass or node was found at the anastomosis level, 80% biopsies were positive for tumour local recurrence. The percentage increases when changes are seen at the retro-anastomotic fat layer.


CONCLUSIONS
In spite of a good correlation between ultrasound abnormalities and positive biopsies, ultrasound findings from the vesico-urethral anastomosis in patients with radical prostatectomy are not well defined. Nodes or ultrasound irregularities can exist in normal prostate fossae as well as normal anastomosis ultrasound in the presence of tumoral relapses. We believe TRU of vesico-urethral anastomosis to be the best method available to evaluate local recurrence or tumoral persistence after radical prostatectomy.
Varo Solís
C
C
Servicio de Urología, Hospital Universitario de Puerto Real, Cádiz.
Bachiller Burgos
J
J
Soto Delgado
M
M
Beltrán Aguilar
V
V
Estudillo González
F
F
D000714:Anastomosis, Surgical; D006801:Humans; D011182:Postoperative Care; D011468:Prostatectomy; D012007:Rectum; D014463:Ultrasonography / Q000379:methods; D014521:Urethra / Q000000981:diagnostic imaging* / Q000601:surgery*; D001743:Urinary Bladder / Q000000981:diagnostic imaging* / Q000601:surgery*