Vesico-urethral anastomosis (VUA) evaluation of short- and long-term outcome after robot-assisted laparoscopic radical prostatectomy (RARP): selective cystogram to improve outcome: Beyond the Abstract

This study shows that we have to be careful with setting aside the cystogram. In a subgroup of patients the cystogram has indeed shown its utility by preventing voiding problems postoperatively. Grading the leakage according to Menon et al., allowed us to correlate the extent of leakage on cystogram with outcome.

Patients with grade 2-3 leakage on cystogram have a higher risk of acute urinary retention after early catheter removal and a higher risk to develop a urethra stricture which means that they will have to undergo an urethrotomy later. By predicting the risk of lekkage, we can avoid unnecessary cystograms and perform a cystogram in a target population (preoperative LUTS and prostate volume >50cc). Thanks to this selection, the health care system and the patient will be the winners:

  • less cystograms: cystogram costs are estimated on 190 euro per cystogram in our institute.  Avoiding 38% of cystograms using our proposed indicators would imply a mean cost reduction of 72.20 euros per patient cost while reducing postoperative catheter time to one week in 12% that will show low grade leakage at first cystogram but will have their TUC removed regardless.
  • less complications: complications as acute urine retention, urethra stricture followed by urethrotomy are a burden not only for the patient (considering the quality of life) but also for the health care system (financial burden, burden on capacity of the operating rooms/hospitalization ect)
The next step following this study will be to develop an algorithm to improve outcome in order to have a risk-adapted decision of cystogram performance. 

Written By: Corinne Tillier, Chair EAUN Scientific Congress Office, European Association of Urology Nurses, Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands

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