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Daniel Oppenheimer, M.D. Daniel_Oppenheimer@urmc.rochester.edu Brett Talbot, M.D. Shweta Bhatt, M.D. Ravinder Sidhu , M.D. Multi-modality Imaging of Urinary Diversion Complications. Purpose.
Brett Talbot, M.D.
Shweta Bhatt, M.D.
This educational exhibit will discuss current options of surgical urinary diversion and detail the imaging findingsof frequently encountered post operative complications
Axial CECT image of a ureterosigmoidostomy (arrows)
Indiana Pouch continent cutaneous urinary diversion
*Complications can occur 20+ years after surgery, emphasizing the need for close monitoring and frequent follow up
Axial CECT image demonstrates a thick walled enhancing collection in the pre-sacral region (dashed oval) with a focus of luminal gas (arrow) and surrounding infiltrative changes, consistent with abscess
Axial CECT and corresponding PETCT images in a patient recently post-op from radical cystectomy and ileal conduit urinary diversion demonstrates a thin walled peripherally enhancing, peripherally hypermetabolic low attenuation collection in the pelvis (arrow), later proven to be a lymphocele
Axial CECT images demonstrate stomal stenosis (arrow) resulting in bowel obstruction, evidenced by dilated small bowel loops with multiple air fluid levels
Grayscale sonographic image demonstrates moderate right hydronephrosis in a patient with an ileal conduit urinary diversion
1 year later
Initial axial CECT image demonstrates moderate right and severe left hydronephrosis. Chronic hydronephrosis has resulted in parenchymal volume loss in the left kidney one year later
Axial and sagittal reformatted CECT images demonstrate herniation of small bowel loops (thinarrows) through the stoma defect (thick arrow)
Axial CECT images demonstrate enhancement of the left renal pelvis and bilateral ureters (arrows), consistent with inflammation due to infection
Loopogram image demonstrates contrast filling the normal loops of diverting bowel and refluxing up both ureters (arrows), but also extraluminal contrast in the left upper pelvis in an enterocutaneous fistula (dashed oval)
Fluoroscopic images from a nephrostogram demonstrate a stricture at the ureteroenteric anastomosis (arrow), which was subsequently dilated with a 7 mm x 4 cm balloon
Loopogram image (left) demonstrates abrupt non-opacification of the distal left ureter extending proximally secondary to a stricture (arrow). Corresponding coronal reformatted CECT image demonstrates non-opacification of mid-distal ureter secondary to a distal ureteral stricture (arrow).
Nephrostogram/loopogram image demonstrates an irregular stricture in the mid right ureter (arrow), later biopsy proven urothelial carcinoma
Axial CECT demonstrates a large calculus (arrow) layering dependently in the Indiana pouch
Loopogram (left) and coronal reformatted CECT images (right) demonstrate a lobulated filling defect in the distal left ureter (dashed oval, arrow), later biopsy proven urothelial carcinoma recurrence