Computed tomography urography, three-dimensional computed tomography and virtual endoscopy

3-Dimensional computerized tomography in follow-up of patients with urinary diversion

INTRODUCTION

The aim of our study was to evaluate the usefulness of 3-dimensional computerized tomography (3D-CT) in routine follow-up of patients who had undergone radical cystectomy and different kinds of urinary diversions and compare it with conventional CT.

PATIENTS AND METHODS

Nineteen patients (18 men, 1 woman) who had undergone radical cystectomy and different kinds of urinary diversions with diagnosis of invasive bladder cancer were enrolled into the study. The mean age of the patients was 55.5 (46-69) years. For all patients, conventional CT was performed, followed by 3D reconstruction of these images.

RESULTS

Orthotopic ileal neobladder (Abol-Enein and Ghoneim procedure) was performed in 12, rectosigmoid pouch (Mainz pouch II) in 2 and ileal conduit in 5 patients. There were no pathological findings visible either on conventional CT or on 3D-CT, but the shape, configuration, and the relationships of the pouch with ureters, urethra and other adjacent organs were much better visualized on 3D-CT.

CONCLUSION

3D-CT did not have any advantages over conventional CT for showing pathological findings that were oncological origin, but as the anatomy of the lower urinary tract can be perfectly demonstrated, we think that it may be used for planning of a re-operation after urinary diversion and may help the urologist who has less experience with radiological studies to evaluate pouch configuration and indentations to the adjacent organs better.

Complications of pneumatic ureterolithotripsy in the early postoperative period

PURPOSE

To document the perioperative and early postoperative complications of pneumatic ureterolithotripsy.

PATIENTS AND METHODS

Between January 1997 and December 2003, pneumatic ureterolithotripsy was performed in 665 male and 314 female patients for stones >0.5 cm. The age range was 9 months to 72 years (mean 41 years). Preoperatively, intravenous urography, urinalysis, and urine culture were done. Cefepime 1 g was given as prophylactic antimicrobial therapy 1 hour prior to surgery. A plain film of the urinary tract was taken immediately before the procedure. The operations were carried out with the patient under general anesthesia. Rigid ureteroscopes (6.9F ACMI "micro-6" or 8F-10F Storz) and the Vibrolith (Elmed, Ankara, Turkey) pneumatic lithotripter were used. The fragments were extracted with forceps or baskets. Urinalysis and culture as a routine postoperative evaluation and a plain film or ultrasonogram of the urinary tract when needed were done 1 week after the procedure.

RESULTS

The stones were completely removed in 847 patients (86.5%); 783 (80%) of them went home on the day of surgery. A ureteral stent was needed in 401 patients (41.0%). Perioperative complications were migration of the stone into the kidney in 70 patients (7.2%), mucosal damage in 34 (3.5%), ureteral perforation in 17 (1.7%), ureteral avulsion in 4 (0.4%), and conversion to open surgery in 3 (0.2%). During the early postoperative period, flank pain (18.4%), pelvic discomfort (5.5%), macroscopic hematuria (7.3%), and urinary tract infection (5%) were recorded.

CONCLUSION

Ureterolithotripsy by a pneumatic lithotripter is a minimally invasive, highly tolerable procedure with a low complication rate and short hospital stay when performed meticulously with appropriate instruments.