THE RECENT ROLE OF MR UROGRAPHY IN FOLLOW UP OF URINARY DIVERSION PATIENTS

Abstract

Radical cystectomy is a major surgical procedure with high risk of development of complications requiring proper preoperative preparation; follow up at both the early and late postoperative period. Formal guidelines for follow-up after urinary diversion has not yet been established so what we suggest is a follow-up strategy addressing early and late postoperative complications. An initial radiological assessment in the first three months is advised followed by a constant interval (six months) radiological follow ups. The choice of the proper imaging modality used varies for each patient depends on inputs from clinical, laboratory & operative data as well as different specifications of each imaging modality. The role of radiologist includes: • Pre-operative Evaluation of the urinary tract to have a baseline evaluation of the upper urinary tract. This would be helpful in monitoring changes that may develop in the future. • Early postoperative - Determine the integrity of the diversion. - Detect any complications such as leaks from the pouch or at the sites of the anastomosis. • late postoperative - Assess the capacity of the reservoirs. - Presence of ureteric reflux - Monitor upper tract changes. - Detect potential complications of the procedure. (Hanna and Badawy, 2009) The used Imaging studies include: • Ultrasound is the basic initial study being very useful in monitoring the kidneys and detecting hydronephrotic changes. • Intravenous urography (IVU) and retrograde loopogramorpouchography were the two classic imaging methods used for evaluating the urinary diversions. • CTU is a superior alternative to IVU allowing excellent evaluation of the urinary tract and the integrity of the urinary diversion with multiplanar and 3D imaging. • MRU is an effective alternative to CTU in patients with contraindications to the use of ionizing radiation or use of iodinated contrast agents (as iodine allergy & poor renal function) or frequent follow-ups. A plain CT is recommended in addition to MRU.