Urinary diversion is created after a removal of the urinary bladder (radical cystectomy or cystoprostatectomy, usually done to treat invasive bladder cancer).
There are three main varieties:
- neobladder formed from a segment of ileum ("ileal conduit", also known as "Bricker conduit")
- the segment of ileum extends to an ostomy on the abdominal wall
- neobladder reservoir formed from bowel with cutaneous diversion , e.g.
- Indiana pouch: formed from cecum and terminal ileum
- Kock ileal reservoir: formed entirely from distal ileum
- Mitrofanoff technique: bladder augmented with a segment of small bowel, and the appendix is used as a conduit to the abdominal wall
- "orthotopic" neobladder
- e.g. Studer pouch, T-pouch neobladder, W-reservoir, Kock ileal pouch
- an isoperistaltic, tubular segment of ileum is formed into a pouch
- the outlet is the native urethra
The types of urinary diversion with a reservoir or neobladder are considered "continent" types of urinary diversion.
The imaging appearance depends on the type of neobladder formed.
Methods of radiological assessment include, all modalities, with a unique fluoroscopic study being a loopogram via the conduit stoma.
Treatment and prognosis
- ileus or small bowel obstruction
- bowel ischaemia
- anastomotic leak
- urine leak and urinomas
- fistula formation
- ureteroenteric and neovesical-urethral anastomotic stricture
- worsening renal failure
- urinary diversions
- treatment for urinary calculi
- prostate interventions
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- 2. Nam JK, Kim TN, Park SW et-al. The Studer orthotopic neobladder: long-term (more than 10 years) functional outcomes, urodynamic features, and complications. Yonsei Med. J. 01;54 (3): 690-5. doi:10.3349/ymj.2013.54.3.690 - Free text at pubmed - Pubmed citation
- 3. Sudakoff GS, Guralnick M, Langenstroer P et-al. CT urography of urinary diversions with enhanced CT digital radiography: preliminary experience. AJR Am J Roentgenol. 2005;184 (1): 131-8. doi:10.2214/ajr.184.1.01840131 - Pubmed citation