Presentation
Patient post left nephrectomy and partial right nephrectomy complicated by a renal-cutaneous fistula with recurrent perinephric infection. He then underwent surgery to treat the fistula.
Patient Data
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Antegrade pyelography / nephrostogram for evaluation of an ileal interpostion between the right renal pelvis and the bladder.
As water soluble contrast fills the collecting system it enters the bowel loop and gradually proceeds antegrade toward the bladder.
There had been a right ureteral stent which had migrated entirely into the bladder, as can be seen on the scout image.
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CT correlate: A midly dilated, tortuous loop of ileum extends from the right renal pelvis to the bladder. The renal pelvis is not dilated.
Case Discussion
If a ureter is partially damaged, it can be bypassed with a nephroureteral stent, but if it needs to be removed, then options such a psoas hitch or transureteroureterostomy can be considered.
If the entire ureter needs to be removed, then an ileal ureter interposition can be considered. Colon could also potentially be used. In a way, the interposition graft concept is a variant of neobladder (such as an ileal conduit), except it is creation of a neo-ureter.
A ileal ureter interposition can be evaluated with
- CT urography
- intravenous urography
- radionuclide studies
- ultrasound
- cystography
Complications of an ileal interposition include mucus formation and stone formation in the ileal segment.
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