Caveats when interpreting intravenous urograms following ileal orthotopic bladder substitution

Abstract

The aim of this study was to evaluate the appearance of the upper urinary tract following cystectomy and ileal orthotopic bladder substitution. Intravenous urograms (IVUs) performed preoperatively and at regular intervals postoperatively on 87 long-term survivors (minimum survival, 5 years) following ileal orthotopic bladder substitution were reviewed. Distention of the collecting system with blunted or rounded fornices was defined as dilatation. If in addition contrast medium excretion was delayed on the 5-min film, this was defined as obstruction. Collecting system dilatation was present on all IVU films obtained from most patients (80%) within 6 months of surgery, even in the absence of urinary tract obstruction. In contrast, dilatation was commonly seen only on the 20-min postinjection films (79%) on urograms performed more than 1 year following surgery, but not encountered on the other two postinjection radiographs (at 5 and 60 min). Five years after surgery, permanent obstruction was observed in only five (3%) renoureteral units. Dilatation of the upper urinary tract after ileal orthotopic bladder substitution is a frequent finding on the 5-min, 20-min, and 60-min films during the early postoperative period but is found only on the 20-min film 1 year and later after surgery. These findings should not be overinterpreted as obstruction.

Three-Dimensional Computed Tomography of the Orthotopic Ileal Neobladder Reconstruction: Normal and Abnormal Findings

“…Some features such as pouch configuration, angle between the pouch and urethra, indentations due to adjacent organs, shape and capacity of neobladder are related to the different types of surgical procedure and are much better displayed on 3D-CT [4,6,7,10] , which improves the confidence of urologist [3,6] .…”

“…Several methods of continent urinary diversion have been developed in order to obtain a reservoir with high capacity, low pressure and no reflux, and to preserve urinary continence [1,3] .…”