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CT Urography of Urinary Diversions with Enhanced CT Digital Radiography: Preliminary Experience

¹ Department of Radiology, Medical College of Wisconsin, Froedtert Hospital, 9200 W Wisconsin Ave., Milwaukee, WI 53226.
² Department of Urology, Medical College of Wisconsin, Milwaukee, WI 53226.
³ Medical College of Wisconsin, Milwaukee, WI 53226.

View larger version (66K): [in a new window]   Fig. 1A. —63-year-old man with ileal conduit urinary diversion. Schematic diagram shows configuration of ileal conduit. Ureteroenteric anastomosis (arrows) is depicted as refluxing Wallace-type anastomosis.

View larger version (138K): [in a new window]   Fig. 1B. —63-year-old man with ileal conduit urinary diversion. Coronal maximum-intensity-projection CT image shows ileal conduit (IC) after cystectomy for bladder cancer. Ureteroenteric anastomosis (arrows) is end-to-side, refluxing Bricker type.

View larger version (66K): [in a new window]   Fig. 2A. —71-year-old man with right colonic pouch urinary diversion after cystoprostatectomy. RCP = right colonic pouch. Schematic diagram shows configuration of RCP. This is continent, catheterizable urinary diversion.

View larger version (142K): [in a new window]   Fig. 2B. —71-year-old man with right colonic pouch urinary diversion after cystoprostatectomy. RCP = right colonic pouch. Coronal maximum-intensity-projection CT image shows RCP. Distal left ureteral segment (arrows) is not opacified.

View larger version (139K): [in a new window]   Fig. 2C. —71-year-old man with right colonic pouch urinary diversion after cystoprostatectomy. RCP = right colonic pouch. Enhanced CT digital radiograph of patient shows RCP and complete opacification of distal left segment (arrows).

View larger version (71K): [in a new window]   Fig. 3A. —66-year-old man with orthotopic neobladder urinary diversion after cystectomy for bladder cancer. NB = neobladder. Schematic diagram shows configuration of orthotopic NB. Ureteroenteric anastomosis (arrows) is refluxing Wallace-type anastomosis.

View larger version (120K): [in a new window]   Fig. 3B. —66-year-old man with orthotopic neobladder urinary diversion after cystectomy for bladder cancer. NB = neobladder. Coronal maximum-intensity-projection CT image of patient with orthotopic NB. Ureteroenteric anastomosis (arrowhead) is refluxing Wallace-type anastomosis.

View larger version (46K): [in a new window]   Fig. 4A. —66-year-old man with ileal conduit and antirefluxing ureteroenteric anastomosis. Schematic diagram depicts creation of split-nipple antirefluxing ureteroenteric anastomosis. Ureter is cut longitudinally and folded back on itself to form a cuff (insert, 1 and 2). Distal ureteral cuff is inserted so that cuff protrudes into lumen of urinary reservoir. Distention of urinary reservoir causes walls of ureteral cuff to coapt, thereby preventing ureteral reflux.

View larger version (101K): [in a new window]   Fig. 4B. —66-year-old man with ileal conduit and antirefluxing ureteroenteric anastomosis. Coned-down oblique coronal maximum-intensity-projection CT image of ileal conduit and antirefluxing ureteroenteric anastomosis. Well-circumscribed defect (arrows) is seen within lumen of ileal conduit (IC) that corresponds to invaginated split-nipple ureteroenteric anastomosis.

View larger version (104K): [in a new window]   Fig. 5A. —69-year-old man with recurrent pelvic tumor after cystectomy. NB = neobladder Axial IV contrast–enhanced CT image of pelvis, obtained with patient in prone position, shows tumor encasing afferent limb (arrows) of NB.

View larger version (101K): [in a new window]   Fig. 5B. —69-year-old man with recurrent pelvic tumor after cystectomy. NB = neobladder Oblique coronal maximum-intensity-projection CT image shows afferent limb (arrowheads) and reservoir of NB. Tight stricture (arrow) can be identified where tumor is encasing distal aspect of afferent limb of NB.

View larger version (142K): [in a new window]   Fig. 6A. —48-year-old woman with right colonic pouch urinary diversion and narrowing of distal left ureter. Axial IV contrast–enhanced CT image shows vascular compression of left ureter (arrowheads) by inferior mesenteric artery and vein (arrow).

View larger version (184K): [in a new window]   Fig. 6B. —48-year-old woman with right colonic pouch urinary diversion and narrowing of distal left ureter. Oblique coronal maximum-intensity-projection CT image shows right colonic pouch (RCP). Overlying inferior mesenteric artery and vein produces narrowing (arrow) of distal left ureter.

View larger version (145K): [in a new window]   Fig. 7A. —54-year-old man with ileal conduit (IC) urinary diversion and distal right ureteral stricture after cystectomy for bladder cancer. Coronal maximum-intensity-projection CT image shows distal right ureteral stricture (arrow). Surgical revision of distal right ureter confirmed benign stricture. IC = ileal conduit.

View larger version (159K): [in a new window]   Fig. 7B. —54-year-old man with ileal conduit (IC) urinary diversion and distal right ureteral stricture after cystectomy for bladder cancer. Contrast-enhanced CT digital radiograph shows distal right ureteral stricture (arrow) and IC.

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