Type:
Educational Exhibit
Keywords:
Fistula, Abscess, Pyelography, Contrast agent-other, Complications, CT, Urinary Tract / Bladder, Pelvis, Haemorrhage
Authors:
S. L. Rodrigues1, D. Fonseca2, N. Costa3, H. S. Rodrigues Duarte3, L. H. C. B. Samouco4; 1Chaves/PT, 2Senhora da hora/PT, 3Porto/PT, 4101/PT
DOI:
10.26044/ecr2019/C-0674
Background
Bladder cancer is the fifth most common malignancy.
Transitional cell carcinoma (TCC) accounts for 90% of primary neoplasm of the bladder.
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 with reconstruction 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 may be preferred if the patient will have trouble self-catheterising.
In this procedure (Figure 1):
- An ileal segment is isolated,
with about 15-20 cm long and both ureters are implanted to its proximal loop.
- The distal loop provides an urinary drainage to a cutaneous stoma.
The ileal stoma is usually located in the right flank.
- The isolated ileal segment continues to peristalse,
which helps improve the passive drainage of urine.
The isolated ileal segment is typically located in the right lower quadrant.
- Gastrointestinal continuity is restored with an ileal-ileal anastomosis.
Compared to another techniques,
the ileal conduit is a less technically challenging surgical procedure and is preferred particularly in older patients with comorbidities,
decreased renal function,
poor prognosis and limited life expectancy.
Fluoroscopic study is still useful for rapidly check of anastomotic patency and leaks.
However this imaging technique has significant limitations.
Multidetector CT (MDCT) urography is useful to visualize and understand the operated abdomen and to detect iatrogenic complications.
Advantages of MDCT urography over fluoroscopic studies include the ability to detect and characterize extra-urinary findings and to better identify another uroepithelial lesions.
Familiarity with the normal postoperative anatomy and with optimal CT technique is essential to realize correct diagnosis.