Learning objectives
To review and to illustrate the surgically altered anatomy and expected imaging findings following radical cystectomy with ileal conduit used for urinary reconstruction.
To review common and unusual complications.
Background
Bladder cancer is the fifthmost common malignancy.
Transitional cell carcinoma (TCC)accounts for 90% of primary neoplasm of thebladder.
It typically occurs in elderly men and is related to smoking or occupational exposure to carcinogens.
Radical cystectomy remains the basis of curative treatment for urothelial carcinoma of the bladder and involves removal of the bladder withreconstruction of the urinary tract.
Ileal conduit construction is one of the incontinent techniques for ureteral reconstruction in patients submitted at radical cystectomy.
Although it is not a continent diversion,
it...
Findings and procedure details
Early and late postsurgical complications are common.
CT is an accurate method for detecting these complications.
MDCT urography must be performed after the oral administration of water or of furosemide intravenously 15-20 minutes before the study (to increase renal excretion and urinary tract distention).
Oral contrast is administered if there is a suspicion of an intestinal leak presence.
It is important to scanning three phases:
Without contrast: to detect stones or any other calcifications.
Nephrogenic phase at 80-100s: to characterize renal or urethral lesions,
and...
Conclusion
Most surgeons increasingly rely on early postoperative imaging.
Knowledge of the expected postoperative anatomy after urinary diversions with optimal CT technique is essential to recognize complications following radical cystectomy and to prevent misdiagnosis of a tumor recurrence.
References
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Bacterial adherence in the human ileal conduit: a morphological and bacteriological study.
J Urol 1984; 132(1):184–188.
Moomjian LN,
Carucci LR,
Guruli G,
Klausner AP.
Follow the Stream: Imaging of Urinary Diversions.
RadioGraphics 2016; 36:688–709.
Banner MP,
Pollack HM,
Bonavita JA,
Ellis PS.
The radiology of urinary diversions.
RadioGraphics 1984;4(6):885–913.
Catalá V,
Solá M,
Samaniego J,
Martí T,
Huguet J,
Palou J,
Torre P.
CT findings in urinary diversion after radical cistectomy: postsurgical anatomy and complications.
Radiographics 2009;...