Orthotopic neobladder reconstruction: Findings on excretory urography and CT

OBJECTIVE. The excretory urographic and CT appearance of orthotopic ileal n eobladder reconstruction after cystectomy and its complications are describ ed. MATERIALS AND METHODS. We retrospectively reviewed the excretory urograms a nd CT scans of 32 patients (29 men and three women, 35-76 years old) with t ransitional cell carcinoma of the bladder who underwent orthotopic neobladd er reconstruction with anastomosis to the native urethra after cystectomy. The radiologic review consisted of 25 excretory urograms in 20 patients and 37 CT scans in 21 patients. RESULTS. On excretory urography, the afferent segment of the neobladder was identified as a contrast-filled structure in all 20 patients, and was loca ted in the right lower quadrant in 18 (90%). On CT, the afferent segment an d the neobladder were identified in all 21 patients. Delayed imaging perfor med after initial scanning in 12 (57%) of 21 patients was helpful for revea ling detailed anatomy such as the ureteral-afferent limb anastomoses. Compl ications occurred in two patients and were caused by a lymphocele in one an d a urine leak from the neobladder in the other. In six other patients we f ound evidence of recurrent or metastatic tumor or both: two had local pelvi c recurrence and pelvic nodal metastases, two other patients had metastatic nodal disease, one patient had a malignant distal ureteral stricture, and the sixth patient had distant osseous metastases. CONCLUSION. Orthotopic neobladder reconstruction after cystectomy has a cha racteristic appearance on both excretory urography and CT. Knowledge of thi s appearance and the altered anatomy is useful to recognize complications a nd tumor recurrence. Delayed images during excretory urography and CT are u seful to define the ureteral-afferent limb anastomosis with the neobladder and also to differentiate between postoperative collections.