Contrast-Enhanced Ultrasound (CEUS) and elastographic imaging

Ultrasound imaging has found applications in several areas of interventional urology prior to treatment (diagnosis), after treatment (follow-up), and also during treatment (monitoring/guidance). Contrast-enhanced ultrasound (CEUS) imaging and elastographic imaging are the two widely used imaging techniques. CEUS modalities, such as harmonic and multi-pulse imaging, are increasingly applied in interventional urology, because the contrast agents give a clear enhancement of blood vessels in the tissue. Among others, CEUS is used to study the microvasculature of the prostate and kidney for cancer detection to more accurately identify malignant lesions. Elastography is a technique that has been coined in 1991 for the quantification of elastic properties of biological tissue. Various elastographic techniques have been developed, such as Acoustic radiation force imaging (ARFI) and shear wave elastography. These techniques have found various applications in interventional urology such as monitoring the degree of fibrosis in renal allografts after transplantation and the identification of renal masses and prostatic lesions.\u3cbr/\u3eThese enhanced ultrasound modalities represent novel techniques in the evaluation of the prostate and kidney in urology. There are multiple putative benefits of enhanced ultrasound modalities, including improved targeting for prostate biopsy; improved characterization of suspicious renal masses, especially when contrast-enhanced axial imaging (CT or MRI) are contraindicated; and lower cost than CT or MRI. Further investigations and refinements are necessary to define the role of these techniques in current urologic practice

Laparoscopic radical prostatectomy: omitting a pelvic drain

PURPOSE: Our goal was to assess outcomes of a selective drain placement strategy during laparoscopic radical prostatectomy (LRP) with a running urethrovesical anastomosis (RUVA) using cystographic imaging in all patients. Materials and Methods: A retrospective chart review was performed for all patients undergoing LRP between January 2003 and December 2004. The anastomosis was performed using a modified van Velthoven technique. A drain was placed at the discretion of the senior surgeon when a urinary leak was demonstrated with bladder irrigation, clinical suspicion for a urinary leak was high, or a complex bladder neck reconstruction was performed. Routine postoperative cystograms were obtained. RESULTS: 208 patients underwent LRP with a RUVA. Data including cystogram was available for 206 patients. The overall rate of cystographic urine leak was 5.8%. A drain was placed in 51 patients. Of these, 8 (15.6%) had a postoperative leak on cystogram. Of the 157 undrained patients, urine leak was radiographically visible in 4 (2.5%). The higher leak rate in the drained vs. undrained cohort was statistically significant (p = 0.002). Twenty-four patients underwent pelvic lymph node dissection (8 drained, 16 undrained). Three undrained patients developed lymphoceles, which presented clinically on average 3 weeks postoperatively. There were no urinomas or hematomas in either group. CONCLUSIONS: Routine placement of a pelvic drain after LRP with a RUVA is not necessary, unless the anastomotic integrity is suboptimal intraoperatively. Experienced clinical judgment is essential and accurate in identifying patients at risk for postoperative leakage. When suspicion is low, omitting a drain does not increase morbidity