Radiology and Follow-Up of Urologic Surgery

Description

The first guide to identifying and assessing changes following urologic surgery—with follow-up protocols

What is the normal appearance of a kidney after radio frequency ablation of a tumor and what does a local recurrence look like? How does the urine flow down the ureters after a trans-uretero-ureterostomy? What is the normal appearance of the urinary tract after a cystoplasty? Most clinicians would be hard-pressed to provide answers to such fundamental questions concerning post-surgical anatomy and physiology, and equally challenged to find evidence-based information on the subject.

Most of the literature in radiology and urologic surgery is orientated towards diagnosis and disease management. Although this often includes complications and outcomes, the clinician is often in the dark as to the anatomical and physiological changes that follow successful treatment—especially in cases involving conservative or reconstructive surgery. To rectify this, the editors invited colleagues to share insights gleaned during their careers. The results are contained in Radiology and Follow-up of Urologic Surgery.

Extremely well-illustrated throughout with color photographs and line drawings, Radiology and Follow-up of Urologic Surgery:

• Features sections devoted to each of the organs of the genito-urinary tract with chapters covering the major diseases and operations that are used to treat them
• Focuses on the “new normal” following surgery with an emphasis on the identification of normal changes versus complications
• Covers the radiologic changes and biochemical and histological findings which are found following reconstructions
• Offers guidelines for clinical and radiological follow up after urological surgery in some key areas

Radiology and Follow-up of Urologic Surgery is essential reading for surgical residents in urology, as well as radiology residents specializing in urology. It also belongs on the reference shelves of urologists, urological surgeons, obstetric/gynecologic surgeons, and radiologists with an interest in the field, at whatever stage in their career.

Table of Contents

List of Contributors
Acknowledgements

Introduction
Christopher Woodhouse and Alex Kirkham

1 Subtotal Nephrectomy and Tumour Ablation 5
David Nicol, Alison Elstob, Christopher Anderson, and Graham Munneke

Introduction 5

Procedures 5

Partial Nephrectomy 5

Early Imaging 6

Late Imaging 7

Ablative Therapies 10

Complications 13

Successful Tumour Ablation 14

Treatment Failure 15

Surveillance 18

Follow-up Imaging 18

Partial Nephrectomy 18

Ablative Therapies 19

Surveillance 19

Conclusions 19

References 20

2 Renal Transplantation 23
Rhana H. Zakri, Giles Rottenberg, and Jonathon Olsburgh

Introduction 23

The Role of Ultrasound Imaging 23

Vascular Complications 23

Transplant Renal Artery Stenosis 23

Transplant Renal Vein Thrombosis 25

Transplant Renal Artery Thrombosis 26

Arteriovenous Fistula 27

Follow-up 27

Urological Complications 27

Ureteric Complications 28

Anastomotic Urinary Leak or Urinoma 28

Missed Duplex Transplant Ureter 29

Ureteric Stenosis 30

Transplant Ureteric Reflux 30

Bladder Complications 30

Urinary Fistulae 30

General Complications 31

Lymphocoeles 31

Renal Transplant Stone Disease 31

Renal Transplant Trauma 32

Oncological Complications 32

Transplant Renal Cell Carcinoma 32

Transplant Ureteric Transitional Cell Carcinoma 33

Conclusions 33

References 34

3 Imaging After Endo-urological Stone Treatment 37
Daron Smith and Clare Allen

Introduction 37

The Procedures 37

Conservative Management 37

Ureteric Stones: Results and Complications 41

Extracorporeal shock wave lithotripsy 41

Ureteroscopy 41

Renal Stones: Results and Complications 44

Flexible Ureterorenoscopy 44

Percutaneous Surgery 46

Complications and Follow-up 48

Residual Fragments After ESWL, URS, FURS and PCNL 48

Radiation Exposure for Patients with Stones 53

References 54

4 Pelvi-ureteric Junction Reconstruction 57
Mohamed Ismail and Hash Hashim

Introduction 57

Antenatal Hydronephrosis 57

Pathophysiological Effect of True Pelvi-ureteric Obstruction 58

Physiological and Anatomical Changes in the Kidney Following Pyeloplasty 59

Incidental PUJO in adults 61

Long-term Follow-up 62

Conclusions 63

References 64

5 Retroperitoneal Fibrosis 67
Paul Scheel and Bruce Berlanstein

Introduction 67

Available Treatments 67

Medical Therapy 67

Surgical Treatment 69

Follow-up 70

Imaging 70

Stent Removal 70

Complications 71

Stent-related Complications 71

Hydrocoeles 73

Long-term Follow-up 73

Recurrent Disease 74

References 75

6 Urinary Diversion 77
Christopher Woodhouse and Alex Kirkham

Introduction 77

The Procedures 77

Clinical Follow-up of Ileal Conduits 78

Postoperative Imaging 78

The ‘Loopogram’ 78

Ultrasound 81

Nephrostomy and Antegrade Imaging 83

Monitoring of Asymptomatic Patients 83

Management of Bacteriuria and Sepsis 84

References 85

7 Ureteric Reconstruction and Replacement 87
Christopher Woodhouse and Aslam Sohaib

Introduction 87

Procedures 87

Stents and Nephrostomies 87

Uretero-pyelostomy 87

Uretero-calycostomy 88

Trans-uretero-ureterostomy 88

Ureteric Re-implantation 88

Autotransplantation 90

Intestine 90

Complex Lower Urinary Tract Reconstruction 90

Other Materials and Experimental Techniques 90

Clinical Follow-up and Complications 91

Stents and Nephrostomies 91

Reconstruction with Urothelium 94

Autotransplantation 95

Intestine 96

References 98

8 Conservative and Reconstructive Bladder Surgery 101
Pardeep Kumar

Introduction 101

Extravasation 101

Bladder Perforation 101

Reconstruction Following Ureteric Injury and Partial Cystectomy 103

The Irradiated Bladder 106

Complications After Posterior Exenteration 106

Conclusions 107

References 107

9 Bladder Augmentation in Children 109
Paddy Dewan and Padma Rao

Introduction 109

The Procedures 109

Augmentation with Ileum or Colon 109

Gastrocystoplasty 109

Seromuscular Cystoplasty 109

Auto-augmentation 110

Uretero-cystoplasty 110

Clinical Follow-up 111

Postoperative Imaging 113

Complications of Enterocystoplasty 115

Metabolic and Electrolyte Disorders (see also Chapter 11) 115

Stones 115

Perforation 117

Neoplastic Progression 118

Unique Complications of Gastrocystoplasty 119

Hypochloraemic Metabolic Alkalosis 119

Hypergastrinaemia 119

Haematuria-Dysuria Syndrome 120

Changes Over Time 120

References 121

10 Radiology and Follow-up of the Neobladder 125
Richard Hautmann and Bjoern G. Volkmer

Introduction 125

The Procedure 125

Radical Cystectomy in Females (Figure 10.1) 125

Radical Cystectomy in Males (Figure 10.2) 125

The Neobladder 125

Postoperative Imaging 126

Clinical Follow-up 127

Clinical Examination 127

Bladder and Urine Investigations 128

Renal Investigations 128

Oncologic Follow-up Specific to the Neobladder 132

Local Recurrence 132

Secondary Tumour Growth in Urinary Diversions for Benign Disease (see also Chapter 11) 134

Complications: Lessons Learned from 1000 Neobladders at Ulm 135

Complications up to 90 Days 135

Long-term Complications 135

Changes Over Time 136

Reservoir Control 136

Incontinence 136

Voiding Failure (Hypercontinence) 136

Metabolic Changes (see also Chapter 11) 138

References 138

11 General Consequences of Lower Urinary Tract Replacement and Reconstruction 141
Christopher Woodhouse and Alex Kirkham

Introduction 141

Reservoirs 141

The Stomach 141

Ileum 141

Gastrointestinal Consequences 142

Storage Consequences 143

Colon 143

Gastrointestinal Consequences 143

Storage Consequences 143

Rectum 145

Continence (Mainz II) 146

Anastomotic Cancer 147

Urodynamic Findings 149

Stones 149

Renal Function 151

Perforation 151

Histological Changes 153

Infection 155

Neoplasia 156

Urine Testing for Pregnancy 157

The Conduit and Continence 157

References 158

12 Surgery on the Benign Prostate 163
Doug Pendse and Mark R. Feneley

Introduction 163

Procedures 163

Outcomes and Complications 165

Postoperative Failure to Void 166

Continued Failure to Void or Unsatisfactory Voiding 166

Sexual Function 168

Incontinence 170

Stricture 170

Unexpected Malignancy 171

Changes Over Time 171

References 172

13 Imaging After Treatment of Prostate Cancer 177
Alex Kirkham

Introduction 177

Appearances After Radical Prostatectomy 177

Residual Tumour After Radical Prostatectomy 179

The Prostate After Ablative Therapies 179

Early Appearances 180

Early Complications 181

Appearances at 2–5 Months 182

Appearances at 6 Months: Assessing Residual and Recurrent Tumour 182

Nuclear Medicine Studies 184

A Schedule for Follow-up 184

References 184

14 Urethroplasty 189
Simon Bugeja, Clare Allen, and Daniella E. Andrich

Introduction 189

Pericatheter Urethrogram 189

Ascending and Descending Urethrography 190

Radiological Appearance After Different Types of Urethroplasty 191

Traumatic Strictures 192

Idiopathic Bulbar Strictures 193

Penile Urethroplasty 193

Use of Ultrasound in Urethroplasty Follow-up 195

Follow-up After Urethroplasty 196

Radiological Appearance and Surgical Management of Recurrent Strictures After Urethroplasty 197

References 198

15 The Postoperative Appearance and Follow-up of Urinary Tract Prostheses 201
Alex Kirkham

Introduction 201

Penile Prostheses 201

Normal Appearance and Imaging Techniques 201

Problems of Positioning and Length 203

Artificial Urinary Sphincters 204

Disorders of Function and Position 205

Infection in Implanted Devices 206

Metallic Stents 208

References 208

Index 211

Author Information

Christopher Woodhouse, MB, FRCS, FEBU is Emeritus Professor of Adolescent Urology, University College, London and previously a consultant at the Royal Marsden Hospital. He trained under Sir David Innes Williams at the Institute of Urology and was made Professor of Adolescent Urology at UCL in 2006.  He is widely considered one of the world’s leading experts in reconstructive urology and in particular, adolescent urology and congenital urological anomalies.  

Alex Kirkham, FRCR, FRCS, MD, is a consultant uro-radiologist, at University College London Hospital, London, UK.