Transrectal ultrasound-cystogram versus X-ray-cystogram versus no cystogram: high volume retrospective study

A comparison among X-ray-cystograms (CGs), TRUS-CGs, and no CG to determine the required indwelling time of urinary catheters after radical prostatectomy (RP).

We retrospectively analyzed patients who underwent robotic-assisted RP in our clinic from January 2018 to October 2022. A primary X-ray-CG was performed before the corona pandemic and a TRUS-CG was performed during the corona pandemic. The primary endpoint was the proportion of CGs needed and the proportion of catheter reinsertions.

We identified 5,307 patients. Of those, 2,803 (52.8 %) did not initially receive a CG, 1643 (31 %) received an X-ray-CG and 861 (16.2 %) received a TRUS-CG. Patients who first had an X-ray-CG were most likely to receive repeated CGs (8.5 % vs. 6.7 % in TRUS patients vs. 0.2 % in patients without CG, P < 0.001). TRUS-CG and X-ray patients had the shortest catheter dwell time [in median 5d vs. 5d (X-ray) vs. 10 d (no CG), P < 0.001], whereas the rate of catheter reinsertion was higher in the TRUS-CG group [5.2 % vs. 4.2 % (X-ray) vs. 1.7 % (no CG), P < 0.001]. There was no statistically significant difference in continence one year after RP between the groups (P = 0.6).In regression models, only operation time [odds ratio (OR):1, P = 0.001] and TRUS-CG (OR: 1.28, P = 0.003) were independent risk factors for incontinence one year after RP and X-ray-CG (OR: 2.4, P < 0.001), TRUS-CG (OR: 2.9, P < 0.001) and operation time (OR: 0.99, P = 0.005) were independent risk factors for catheter reinsertion.

The non-X-ray based method (TRUS-CG) could be safely used to assess the adequacy of the anastomosis, although the catheter reinsertion rate was slightly higher.