CT Findings in Urinary Diversion after Radical Cystectomy: Postsurgical Anatomy and Complications

Violeta Catald, MD , Marta Sold, MD , Jaime Samaniego, MD , Teresa Marti, MD ,Jorge Huguet, MD , Juan Palou, MD , Pablo De La Torre, MD

Numerous surgical procedures have been developed for urinary diver­sion in patients who have undergone a radical cystectomy for bladder cancer or, less frequently, a benign condition. Because urinary diver­sion procedures are complex, early and late postsurgical complications frequently occur. Possible complications include alterations in bowel motility, anastomotic leaks, fluid collections (abscess, urinoma, lym-phocele, and hematoma), fistulas, peristomal herniation, ureteral stric­tures, calculi, and tumor recurrence. Computed tomography (CT) is an accurate method for evaluating such events. Multiplanar reformat­ting and three-dimensional volume rendering of multidetector CT im­age data are particularly useful for achieving an accurate and prompt diagnosis of complications and obtaining information that is essential for adequate surgical management. In addition, knowledge of urinary diversion procedures, normal postsurgical appearances, and optimal CT technique for postsurgical evaluations is essential for detecting complications and avoiding misdiagnosis.