Complications of Ileal Conduits After Radical Cystectomy IR

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Vascular-Interventional Radiography: 2.50
Procedures: 2.50
Nonvascular Procedures: 2.50

Outline

1. Introduction
2. Surgical Anatomy of an Ileal Conduit
   1. Ureteroileal Anastomosis
   2. Cutaneous Stoma
3. General Considerations for Interventional Radiologic Management
4. Early Complications
   1. Urine Leakage
   2. Ureteral Obstruction
   3. Postoperative Fluid Collection
   4. Fistulas
5. Late Complications
   1. Ureteroileal Anastomotic Stricture
   2. Stoma-Related Complications
   3. Conduit Stenosis
   4. Urolithiasis
   5. Upper Urinary Tract Tumor Recurrence
   6. Ureteroarterial Fistula
   7. Stent-Related Complications
6. Conclusion

Objectives

Upon completion of this course, students will:

1. cite the major risk factor for bladder cancer
2. state the percentage of bladder cancers that occur in males
3. list the conditions that radical cystectomy with urinary diversion can help treat
4. list the major techniques used for urinary diversion after radical cystectomy
5. recall the year that ileal conduits were introduced into clinical practice
6. list the patient and tumor factors affecting selection of urinary diversion
7. list the patient types for which ileal conduit is generally used
8. state the ileal conduit complications that require immediate surgical intervention
9. list procedures often performed by interventional radiologists in diagnosis and management of complications related to ileal conduits
10. state the first step of ileal conduit creation
11. explain how the appropriate length of ileal segment is selected
12. state the final step in creating an ileal conduit
13. recall what part of the ileal segment is brought to the skin for stoma creation
14. choose the techniques utilized for creating ureteroileal anastomosis
15. choose the technique that combines the Wallace and Bricker techniques
16. state the techniques currently used to create a cutaneous stoma
17. explain which stoma technique is the most common
18. compare and contrast stoma creation techniques
19. discuss what can be done to prevent respiratory complications when performing a percutaneous nephrostomy on an elderly patient
20. explain which calix is accessed for urine sample during percutaneous nephrostomy
21. state the benefits of loopography as a diagnostic tool
22. list early complications related to ileal conduits that can be managed with interventional radiologic techniques
23. state the reported incidence of urine leakage after conduit urinary diversion
24. explain why it is important to identify urine leaks associated with ileal conduit complications
25. describe how patients with urine leakage may present
26. explain how long nephroureteral stents should be left in place to permit ureteral healing
27. recall the percentage of patients that may experience ureteral obstruction in the early postoperative period
28. describe how patients with ureteral obstruction present
29. choose the imaging modality that provides the study of choice in differentiating types of fluid collection in ileal conduit patients
30. list the risk factors for developing a fistula post ileal conduit
31. recall the overall complication rate related to ileal conduits 20 years after surgery
32. list late complications of ileal conduit surgery that can be managed with interventional radiologic techniques
33. explain how patients with ureteroileal anastomotic stricture may present
34. choose the exam that is useful for assessing the patency of ureteroileal anastomosis
35. explain what patients are best suited for long-term indwelling nephroureteral stent placement
36. choose the most common late complication to occur after conduit diversion
37. list complications associated with stomas following conduit diversion
38. discuss the outcome of unaddressed stomal stenosis
39. state the percent of urolithiasis in patients with an ileal conduit
40. choose the best diagnostic study for depicting ureteroarterial fistula