Imaging of Urinary Diversions

A review of surgical techniques for the most common urinary diversion procedures, the expected imaging appearance, and the role of imaging studies in detecting complications of urinary diversion procedures.

Course ID: Q00504 Category:
Modalities: , ,

3.0

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Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:

Computed Tomography: 3.00
Procedures: 3.00
Abdomen and Pelvis: 3.00

Magnetic Resonance Imaging: 3.00
Procedures: 3.00
Body: 3.00

Registered Radiologist Assistant: 3.00
Procedures: 3.00
Abdominal Section: 3.00

Sonography: 3.00
Procedures: 3.00
Abdomen: 3.00

Vascular-Interventional Radiography: 3.00
Procedures: 3.00
Nonvascular Procedures: 3.00

Outline

  1. Introduction
  2. Incontinent Diversions
    1. Ileal Conduit
      1. Surgical Anatomy
      2. Expected Imaging Findings
        1. IVP Imaging
        2. Abdominopelvic MR Imaging and MR Urography
        3. Loopography
        4. Ultrasonography
      3. Complications
      4. Early Complications
        1. Urine Leak
        2. Bowel Leak (Leakage of Bowel Contents
        3. Alterations in Bowel Function
        4. Fluid Collections
        5. Conduit Necrosis
      5. Late Complications
        1. Stomal Complications: Parastomal Hernia
        2. Stomal Complications: Stomal Stenosis
        3. Strictures
        4. Urolithiasis
        5. Small-Bowel Obstruction
    2. Sigmoid Conduit
      1. Surgical Anatomy
      2. Expected Imaging Findings
      3. Early Complications
      4. Late Complications
        1. Uretero-Bowel Anastomotic Stenosis
        2. Upper Tract Complications
  3. Continent Diversions
    1. Continent Diversion with Catheterizable Cutaneous Stoma: The Indiana Pouch
      1. Surgical Technique
      2. Expected Imaging Findings
        1. Abdominal and Pelvic CT and CT Urography
        2. US Imaging
        3. Pouchography
      3. Complications
      4. Early Complications
      5. Late Complications
        1. Urolithiasis
        2. Stomal Complications
        3. Stricture
    2. Continent Diversion with Anastomosis to Native Urethra: Orthotopic Neobladder
      1. Surgical Anatomy
        1. Studer Pouch
        2. Hautmann Pouch
      2. Expected Imaging Findings
        1. Abdominal and Pelvic CT and CT Urography
        2. Pouchography
      3. Early Complications
      4. Late Complications
        1. Fistula
        2. Ureteral Stricture
        3. Subneovesical Obstruction
        4. Rupture
  4. Recurrent Tumor
    1. Local Tumor Recurrence
    2. Upper Tract Recurrence
    3. Distant Metastases
  5. Conclusion

Objectives

Upon completion of this course, students will:

  1. know the main reason for radical cystectomy and urinary diversion
  2. determine the risk factors for developing bladder cancer
  3. identify organs that may be removed during radical cystectomy surgery
  4. select the appropriate urinary diversion category for the Bricker procedure
  5. identify the patient criteria for the ileal conduit urinary diversion procedure
  6. discuss why preservation of the terminal ileum is important in urinary diversion
  7. discuss CT contrast bolus techniques to reduce radiation exposure when imaging patients with urinary diversions
  8. discuss the importance of identification of the ileal segment on CT for patients with ileal conduit urinary diversion
  9. discuss the IVP procedure for patients with urinary diversion
  10. identify the most appropriate use of MR imaging for patients with urinary diversion
  11. discuss alternate MR imaging techniques if contrast cannot be administered
  12. identify the contrast material used for loopography
  13. describe the normal findings of the ileal conduit and urinary system on loopgraphy
  14. discuss the indications for loopography
  15. identify the indications for postoperative surveillance of the kidneys with ultrasound
  16. discuss the long-term complication rate of patients with ileal conduit and urinary diversion
  17. discuss the consequences of bowel leak after ileal conduit and urinary diversion surgery
  18. identify the CT imaging features of different postoperative fluid collections
  19. know the most appropriate imaging modality to evaluate for stomal stenosis of the ileal conduit
  20. discuss the late features of strictures as a late complication of ileal conduit creation
  21. describe the factors which contribute to stone formation in patients with ileal conduits
  22. discuss patient conditions which may necessitate sigmoid conduit over ileal conduit creation
  23. be familiar with the imaging features of a sigmoid conduit
  24. describe the techniques patients use to void after continent urinary diversion procedures
  25. describe the features of the optimum continent pouch
  26. know the possible locations of the stoma in patients with the Indiana pouch urinary diversion
  27. describe the phases of CT scans to differentiate the gastrointestinal tract from the urinary tract in patients with Indiana pouch urinary diversions
  28. discuss the mimics of the haustra of the Indiana pouch as seen on imaging
  29. identify surgical modifications which has helped reduce the overall incidence of postoperative urine leak after Indiana pouch creation
  30. discuss the cause of urolithiasis in patients with cutaneous continent urinary diversions
  31. know the clinical signs of ureteroenteric anastomotic stricture formation in patients with cutaneous continent urinary diversions
  32. describe the advantages of using the ileum in neobladder creation
  33. describe the mucosal pattern of the afferent limb of the Studer pouch as imaged on CT
  34. discuss the amount of contrast used in the early postoperative evaluation of neobladder on fluoroscopy
  35. be familiar with the most common site for fistula formation in patients with a neobladder
  36. identify the symptoms of fistula formation in patients with neobladder surgery
  37. discuss the causes of spontaneous neobladder rupture
  38. identify structures in which tumor involvement at cystectomy increases the risk of local recurrence
  39. discuss factors which increase the incidence of upper tract tumor recurrence
  40. know the site for common distant metastasis in patients with urinary diversion