Cystography after radical retropubic prostatectomy: Clinical implications of abnormal findings

Objectives: In many institutions, cystography is obtained routinely after radical retropubic prostatectomy to assess the integrity of the vesicourethral anastomosis before the removal of the catheter. This study presents the Indiana experience with cystograms performed following radical retropubic prostatectomy. Methods: The experience with 260 cystograms performed in 245 consecutive patients following radical retropubic prostatectomy was reviewed retrospectively, with a special reference to the clinical implications of abnormal findings. Results: After a standard catheterization period of 14 to 21 days (mean, 19.2), 94.3% of the catheters were removed safely without adverse clinical consequences. The presence of a minimal contained contrast extravasation did not affect outcome after the removal of the catheter. The overall incidence of clinically significant extravasation was found to be 5.7% and was further reduced to 2.4% if extravasation was not suggested clinically in the postoperative course. Conclusions: Based on the current literature, significant extravasation is a common finding during the first 5 to 8 postoperative days. Therefore, management strategies advocating early urethral catheter removal should include routine cystographic studies. Otherwise, cystographic confirmation of anastomotic integrity before the removal of the catheter following 14 to 21 days of catheterization is not indicated in the routine postradical prostatectomy patient.