Presentation
History of ileal conduit formation for bladder cancer. Progressively rising creatinine. Prior noncontrast CT showed dilatation of the left upper collecting system.
Patient Data
In this investigation of the patient's ileal conduit (loopogram), the right kidney fills quickly. The right upper tract is mildly dilated, which is not unexpected for a retrograde study of the kidney.
The left kidney, however, does not fill readily. Eventually a small amount of contrast opacifies the distal left ureter. When the patient is turned into a steep RPO, a short segment narrowing/stricture at the ureteral anastomosis is evident.
On the post void images (draining the conduit), the right upper collecting system decompresses, but the left does not decompress very well and retains a faintly dilated appearance.
The red arrow points to the tight distal ureteroileal stenosis.
A superimposed radiopaque pill measures 12 mm.
Case Discussion
An ileal loop conduit can be investigated with either retrograde urography (loopogram) or with CT urography (CTU), and both have advantages and disadvantages.
CTU allows one to investigate the soft tissues around the urinary diversion more thoroughly than a loopogram does. If there is thickening of the ureter, mass effect on the ileal conduit or ureter, or a filling defect, a CTU may be able to characterize it with more specificity than a loopogram can.
A loopogram, on the other hand, allows a dynamic component to the evaluation of the ileal conduit. A narrowing can be mildly stressed with pressure from contrast and one can watch if the narrowing is fixed and over what length. The rate of opacification (and voiding) also offers diagnostic information, as seen in this case.
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