Follow the Stream: Imaging of Urinary Diversions

Abstract

Urinary diversion is a surgical technique to redirect the stream of urine, most often after cystectomy. Cystectomy may be performed both for benign and for malignant conditions. Bladder cancer is the most common indication for cystectomy, and most patients who undergo radical cystectomy and urinary diversion have muscle-invasive or high-risk non-muscle-invasive bladder cancer. There are two major surgical approaches for urinary diversions performed after radical cystectomy: continent and incontinent diversions. For incontinent urinary diversions, a cutaneous ostomy is used for continuous urine drainage (eg, ileal conduit). With a continent diversion procedure, the patient may void through the native urethra or self-catheterize through a surgically created stoma. The goals of imaging after urinary diversion are to assess postoperative anatomy, detect postoperative complications, evaluate for residual or recurrent tumor and metastatic disease, and monitor for upper tract distention and/or deterioration. Multiple imaging modalities and techniques may be used to evaluate urinary diversions, including computed tomographic and magnetic resonance urography, intravenous pyelography, ultrasonography, pouchography, loopography, and nephrostomy studies. Knowledge of the expected postoperative appearance after urinary diversions and potential postoperative complications is crucial because many complications may be clinically silent. Radiologists must be able to recognize the expected postoperative appearance as well as complications to facilitate appropriate diagnosis and treatment of patients after cystectomy and urinary diversion. (©)RSNA, 2016.

Role of CT in the detection and management of cancer related complications: a study of 599 patients

“…Patient usually presents with abdominal pain within 3–4 weeks of initiation of therapy and it becomes imperative to obtain clinico-radiological correlation in order to prevent further complications associated with pancreatitis. Leakage commonly occurring at anastomotic site, is seen in approximately 4% of patients following urinary diversion, and was seen in 4 of our cases [ 20 ]. An evaluation of excretory phase images is essential in patients with increased output from a drainage catheter or urinary drainage from the wound that might need re-exploration…”

Effect of Educational Intervention and Telephone Follow-Up Program on Knowledge, Practice and Quality Of Life among Patients with Urinary Diversion: A Quasi-Experimental Study

“…Urinary diversion is a surgical technique to redirect the stream of urine, this surgery can lead to some possible long term side effects and the consequent negative impact quality of life . [36] Patients undergo urinary diversion need support care and appropriate knowledge to prevent postoperative surgical complications. So, the purpose of study determine the effect of educational intervention and telephone follow-up program on knowledge, self-care performance and quality of life among patients undergoing urinary diversion.…”

Complications of Ileal Conduits after Radical Cystectomy: Interventional Radiologic Management

“…Contrast material should reflux into the ureters and collecting system unless an antirefluxing technique is used for ureteroileal anastomosis. Loopography can visualize the course and contour of the ileal conduit and the type of ureteroileal anastomosis and help assess the cause of urinary obstruction as well as urine leakage (19). Loopography can also provide a map of the urinary tract when a retrograde approach (approach from the stoma) is used for any interventional radiologic or endourologic procedures.…”

“…In asymptomatic patients, the initial workup includes renal US (to confirm hydronephrosis) or contrastenhanced CT with excretory phase imaging ( Fig 7). CT may demonstrate a cause of obstruction other than ureteroileal anastomotic stricture, such as recurrent tumor involving the ureter or vascular structures compressing the ureter (19).…”

“…Stomal stenosis, if not addressed, can lead to urinary stasis, infection, deterioration of renal function, and perforation of the conduit. The degree and extent of this condition may be best assessed with loopography performed with a lateral projection (19). Stenosis may be treated with digital or balloon dilation with or without drainage catheter (usually a Foley catheter) placement via the dilated stoma.…”