Use of CT in evaluation of postcystectomy patients

Patterns of recurrence of bladder carcinoma following radical cystectomy

The purpose of this study was to describe the imaging features and patterns of disease in patients with recurrent bladder carcinoma following radical cystectomy.

A retrospective review was made of the CT and MR findings in 42 patients (33 male, 9 female, mean age 65.1 years) with histologically verified transitional cell carcinoma of the bladder, who developed recurrent disease following radical cystectomy. Histology confirmed T2 disease in 7 patients, T3 disease in 26 patients and T4 disease in 9 patients. The tumour grade was G3 in 38 patients and G2 in 4 patients. The CT (n = 42) and MR imaging (n = 9) obtained at disease relapse were reviewed, noting the sites of disease recurrence and their imaging appearances.

The mean time to recurrence following cystectomy was 14.6 months (range 2–50 months). Patients with T2 disease had a significantly longer time to recurrence compared with patients with T3 or T4 disease (22.7 vs. 13.0 months, student t-test, P < 0.05). The most common pattern of recurrence was pelvic lymphadenopathy (55%). Retroperitoneal lymphadenopathy was common (33%) and was the only site of nodal disease in 10%. Local pelvic recurrence (45%) appeared as a soft tissue mass, which involved muscle, urethra or vagina. Sites of distant metastasis included the liver (19%), bone (12%) and lungs (10%). Liver metastasis was associated with nodal disease in the majority (80%).

The sites of recurrence of bladder cancer following radical cystectomy are described. Pelvic lymph node involvement is the most frequent site of disease recurrence despite the fact that pelvic lymph node dissection is performed as part of the standard procedure of radical cystectomy.

Clinical Applications of Radioimmunoscintigraphy With Prostate-Specific Antibodies for Prostate Cancer

BACKGROUND: The presence of metastasis is the most important prognostic indicator in patients with prostate carcinoma and is the predominant determinant of therapeutic choices. Current tools for detection of recurrence or metastasis are less than optimal. Recent clinical trials with radiolabeled monoclonal antibodies appear to provide more precise localization of prostate cancer in these clinical circumstances. METHODS: Multicenter national trials of patients at relatively high risk for metastasis at diagnosis and patients with biochemical evidence of recurrence after prostatectomy underwent radioimmunoscintigraphy with capromab pendetide. RESULTS: Tissue confirmation of scan results demonstrated a 15-fold and 4-fold increase in sensitivity over computed tomography and magnetic resonance imaging, respectively, for newly diagnosed patients. Preliminary data have shown a 3- to 4-fold increase in durable complete response to radiation therapy in patients with biochemical failure following radical prostatectomy. CONCLUSIONS: Patients at relatively high risk for metastasis at diagnosis and those with biochemical evidence of recurrence after prostatectomy may benefit from radioimmunoscintigraphy.

Sensitivity of computed tomography in detecting local recurrence of prostatic carcinoma following radical prostatectomy

The aim of this study was to evaluate CT imaging in the post-operative follow-up and in the detection of recurrence after radical prostatectomy in cases of prostatic carcinoma. In over 500 patients undergoing radical prostatectomy for prostatic carcinoma, 22 cases with local recurrence were found. CT examinations of the pelvis were retrospectively evaluated in these patients. Local recurrence was detected by PSA uptake and confirmed by transrectal ultrasound (TRUS) in combination with guided biopsy. In 22 cases of confirmed local recurrence, positive results on CT were found in eight patients (36%) and negative results in nine patients (41%). In the remaining five cases (23%), no distinction could be made between scar and local recurrence. All cases definitively classified as recurrent tumour disease showed a soft tissue mass of 2 cm or more. CT sensitivity in local recurrence of prostatic carcinoma after surgery is low. Even in a very careful follow-up, the understaging would be up to 41%. In comparison, PSA, TRUS and needle biopsy are the methods of choice and are superior to CT imaging. Based on these results, there would be no reason for including pelvic CT examinations in the follow-up of prostatic carcinoma after radical prostatectomy.

The Use of Trus in the Detection and Evaluation of Local Pelvic Recurrences after a Radical Urological Pelvic Operation

Transrectal ultrasound was performed in 19 patients with suspected local pelvic recurrence after a radical pelvic operation: 8 had undergone radical prostatectomy and 11 radical cystoprostatectomy. Transrectal sonography verified the presence of recurrence in 18 of 19 patients (94.7%) and this was confirmed by biopsy of the visualised lesions. Analysis of the sonographic echo patterns encountered revealed that in 14 of 18 recurrent neoplasms (77.7%) the echogenic pattern was hypoechoic. In the remaining 5 patients (26.3%) the echo pattern was isoechoic. No hyperechoic lesions were noted. Based upon our findings and because of the low costs compared to other diagnostic modalities, transrectal ultrasound is an ideal technique to complete digital rectal examination in evaluating patients suspected of local pelvic recurrence after radical pelvic operation.

Ultrasonographic Characteristics of Urethrovesical Anastomosis in the Early Post-radical Prostatectomy Patient

— It is possible that the advent of more aggressive surgical approaches to carcinoma of the prostate, including neoadjuvant and adjuvant therapy, will lead to a higher incidence of pelvic recurrence rates in coming years. A method of sequentially monitoring the region of the urethrovesical anastomosis for early recurrence that is more accurate than digital rectal examination is required. Transrectal ultrasound is an established technique for the preoperative assessment of prostate cancer. It has also been used postoperatively to guide a biopsy needle into palpably suspicious areas of the urethrovesical junction or for random biopsies in patients with elevated prostate specific antigen levels. However, the sonographic anatomy of the postoperative urethrovesical junction has seldom previously been described. In this prospective study we analyse the transrectal sonographic characteristics of the neoanatomy in 20 patients, all within 3 months following surgery for clinically intracapsular disease. We describe features of the neoanatomy, such as anterior tissue nodules and anastomotic rings. Because of distinct variations in the neoanatomy of different patients we recommend early postoperative transrectal biplanar sonography to establish a baseline image for each individual case. This would be useful for later comparison and may prevent a false positive scan on subsequent follow-up studies.

Sonographic characteristics of the urethrovesical anastomosis in the early post-radical prostatectomy patient

It is possible that the advent of more aggressive surgical approaches to carcinoma of the prostate, including neoadjuvant and adjuvant therapy, will lead to a higher incidence of pelvic recurrence rates in coming years. A method of sequentially monitoring the region of the urethrovesical anastomosis for early recurrence that is more accurate than digital rectal examination is required. Transrectal ultrasound is an established technique for the preoperative assessment of prostate cancer. It has also been used postoperatively to guide a biopsy needle into palpably suspicious areas at the urethrovesical junction or for random biopsies in patients with elevated prostate specific antigen levels. However, the sonographic anatomy of the postoperative urethrovesical junction has not previously been described. In this prospective study we analyze the transrectal sonographic characteristics of the neoanatomy in 30 patients, all within 3 months following surgery for clinically intracapsular disease. We describe features of the neoanatomy, such as anterior tissue nodules and anastomotic rings. Because of distinct variations in the neoanatomy of different patients we recommend early postoperative transrectal biplanar sonography to establish a baseline image for each individual case. This would be useful for later comparison and may prevent a false positive scan on subsequent followup studies.

The use of transrectal ultrasound in the detection and evaluation of local pelvic recurrences after a radical urological pelvic operation

Transrectal ultrasound was performed in 20 patients with suspected local pelvic recurrence after a radical pelvic operation: 9 had undergone radical prostatectomy and 11 had undergone radical cystoprostatectomy. Transrectal sonography verified the presence of recurrence in 19 of 20 patients (95%) and this was confirmed by biopsy of the visualized lesions. Analysis of the sonographic echo patterns encountered revealed that in 14 of 19 recurrent neoplasms (71.5%) the echogenic pattern was hypoechoic. In the remaining 6 patients (31.5%) the echo pattern was isoechoic. No hyperechoic lesions were noted. Based upon our findings and because of the low costs compared to other diagnostic modalities transrectal ultrasound represents an ideal technique to compliment the digital rectal examination in evaluation of patients suspected of harboring a local pelvic recurrence after a radical pelvic operation.

Ileourethral fistula following cystectomy: a rare complication

Fistulae between the urinary and intestinal tracts of adult male patients usually result from trauma, inflammatory diseases, necrosis and infiltration of a neoplasm of either the bladder, prostate or colon, or radiation therapy. We report 2 patients who developed an ileourethral fistula following cystectomy which had been performed for carcinoma of the bladder in 1 patient and leukoplakia of the bladder in the other. The diagnosis of an ileourethral fistula was established by retrograde urethrography and a barium follow-through study. Computed tomography performed in 1 patient showed a tumor mass in the pelvis.

Computed tomography of the pediatric pelvis

Computed tomography is a useful imaging modality in infants and children for evaluating pelvic lesions suggested by conventional imaging procedures. Computed tomography can provide anatomic information about abnormalities of the viscera as well as the musculoskeletal structures. Characterization of a lesion as well as determination of its extent is possible by computed tomography. Computed tomography is especially valuable in visualizing the presacral space, in the follow-up of patients with malignant neoplasms and in localizing impalpable testes.