Imaging Pearls ❯ Kidney ❯ Bladder Tumor Surgery: Loops and Diversion
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- “Page kidney or Page phenomenon is an uncommon, potentially reversible form of secondary arterial hypertension, related to excessive activation of the renin/angiotensin hormonal cascade, that can be induced by extrinsic compression of the kidney by subcapsular hematoma, or other perirenal process. Page kidney can be suggested on imaging by the presence of renal contour deformation, and moreover any asymmetrically impaired renal function can manifest on CECT or MRI as a delayed enhancement relative to the normal kidney (“delayed nephrogram”) or abnormal contrast retention on subsequent non-enhanced scans.”
What can go wrong when doing right? A pictorial review of iatrogenic genitourinary complications.
Chahine R, Mendiratta-Lala M, Consul N, et al.
Abdom Radiol (NY). 2024 Jun 4. doi: 10.1007/s00261-024-04384-8. Epub ahead of print. PMID: 38832944. - BCG is an immunotherapy treatment option for noninvasive multifocal bladder cancer, often used following transurethral resection of bladder tumors (TURBT). It involves instillation of Mycobacterium bovis (M. bovis) into the bladder to induce a localized inflammatory reaction that can lead to tumor shrinkage. This treatment can be complicated chronic cystitis, manifested on CT and MRI as diffuse urinary bladder thickening with perivesicular fat stranding, as well as bladder contractures, ulcerations, and hematuria. BCG may also lead to reactivated infection in nearby or distant organs, resulting in epidydimo-orchitis, balanitis, pyelonephritis, aortitis, osteomyelitis, or pulmonary infection.
What can go wrong when doing right? A pictorial review of iatrogenic genitourinary complications.
Chahine R, Mendiratta-Lala M, Consul N, et al.
Abdom Radiol (NY). 2024 Jun 4. doi: 10.1007/s00261-024-04384-8. Epub ahead of print.
- Urinary Diversions: Complications Late complications (after 30 days post-op)
- Stone formation
- Infection
- Reflux to urinary tract
- Obstruction (usually ureteroenteric) - Urinary Diversions: Complications Early complications (under 30 days post-op)
- Bowel complications (ileus, SBO, leak, ischemia)
- Infections (UTI's including pyelonephritis, abscess
- Post operative fluid collections (urinomas, seromas, hematomas)
- Urinary tract complications (anastomotic leak, obstruction, ischemia
- Complications occur in up to 30.9% of cases with ileus most common complication. - Urinary Diversion: Surgeries
- Incontinent, cutaneous diversion
- Continent, cutaneous catheterizable reservoir (pouch)
- Continent urinary diversion to the intact native urethra (orthotopic neobladder) - Urinary Diversion: Reasons Improve or replace function of urinary bladder in patients with either
- Bladder cancer
- Neurogenic bladder dysfunction
- Detrusor overactivitiy
- Chronic inflammatory disease "CT has an important role in postoperative evaluation of patients with urinary diversion to identify correctablle causes early to prevent deterioration in renal function and detect tumor recurrence in patients who had bladder cancer."
Role of CT in Postoperative Evaluation of Patients Undergoing Urinary Diversion
Kawamoto S, Fishman EK
AJR 2010; 194:690-698