FUROSEMIDE UROGRAM IN PATIENTS WITH NEOBL ADDER

To differentiate between urodynamically relevant obstruction and funct ionally unimportant dilation of the upper urinary tract in patients wi th neobladder using a modified furosemide urogram. Method: An excretor y urogram with furosemide loading was carried out in 19 patients with neobladder and sonographically and urographically confirmed dilation o f the upper urinary tract. Once strong contrasting of the renal pelves and calyces has been achieved, 20 mg of furosemide were applied and l ate radiographs were obtained at 15 min and 30 min, respectively. An o bstruction was defined as increasing dilation of the renal pelves and calices during forced diuresis and lack of washout effect of the contr ast medium. Results: In 32 cases, the renoureteral unit (RUU) was dila ted on ultrasound. Of these, 25 RUU's showed good emptyness of contras t medium upon stimulation of diuresis, six RUU's returned a borderline findings, while one RUU was found to exhibit a decompensated anastomo tic stenosis, which was dilated. Two further patients with borderline findings were later treated surgically due to their pain symptoms. No patient required further preoperative diagostic procedures. Conclusion s: The modified furosemide urogram represents a cost-effective diagnos tic orientation strategy in patients with neobladder and dilated renal pelves and calyces and is both well-tolerated by patients and meets w ith broad acceptance from the urologic staff.