Abstract: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, lymphocele, and hematoma), fistulas, peristomal herniation, ureteral strictures, calculi, and tumor recu… Show more
“…However, these patients also can be expected to have benign postoperative findings. Upper tract infection is a known complication of cystectomy and urinary diversion for bladder cancer [30] and was found to be a benign cause of urothelial thickening in one of our patients. The PPV was actually higher in this group (69%, 22/32) than among patients with hematuria alone (49%, 17/35), likely reflecting a stronger bias toward the increased incidence of upper tract tumors in this population.…”
The positive predictive value of CT urography for upper tract urothelial cancer is moderate because benign findings mimic cancer. Positive findings on a CT urogram are more likely to indicate cancer in the setting of large masses or positive urine cytology.
“…However, these patients also can be expected to have benign postoperative findings. Upper tract infection is a known complication of cystectomy and urinary diversion for bladder cancer [30] and was found to be a benign cause of urothelial thickening in one of our patients. The PPV was actually higher in this group (69%, 22/32) than among patients with hematuria alone (49%, 17/35), likely reflecting a stronger bias toward the increased incidence of upper tract tumors in this population.…”
The positive predictive value of CT urography for upper tract urothelial cancer is moderate because benign findings mimic cancer. Positive findings on a CT urogram are more likely to indicate cancer in the setting of large masses or positive urine cytology.
“…In our experience, the detection of fluid or mixed non-haemorrhagic collections in the surgical bed in a postoperative patient with fever and abnormal acute phase reactants is consistent with local infection (Fig. 12) [26–28]. Fig.…”
Section: Postoperative Collectionsmentioning
confidence: 88%
“…An abscess is differentiated from a lymphocele by its thickened, enhancing wall (Fig. 13) [6, 28, 29]. Fig.…”
BackgroundRobot-assisted laparoscopic radical prostatectomy (RALRP) is currently accepted as the preferred minimally invasive surgical treatment for localised prostate cancer, with optimal oncologic and functional results. Despite growing surgical experience, reduced postoperative morbidity and hospital stays, RALRP-related complications may occur, which are severe in 5–7 % of patients and sometimes require reoperation. Therefore, in hospitals with an active urologic surgery, urgent diagnostic imaging is increasingly requested to assess suspected early complications following RALRP surgery.MethodsBased upon our experience, this pictorial review discusses basic principles of the surgical technique, the optimal multidetector CT (MDCT) techniques to be used in the postoperative urologic setting, the normal postoperative anatomy and imaging appearances.ResultsAfterwards, we review and illustrate the varied spectrum of RALRP-related complications including haemorrhage, urinary leaks, anorectal injuries, peritoneal changes, surgical site infections, abscess collections and lymphoceles, venous thrombosis and port site hernias.ConclusionKnowledge of surgical procedure details, appropriate MDCT acquisition techniques, and familiarity with normal postoperative imaging appearances and possible complications are needed to correctly perform and interpret early post-surgical imaging studies, particularly to identify those occurrences that require prolonged in-hospital treatment or surgical reintervention.Teaching points• Robot-assisted laparoscopic radical prostatectomy allows minimally invasive surgery of localised cancer• Urologic surgeons may request urgent imaging to assess suspected postoperative complications• Main complications include haemorrhage, urine leaks, anorectal injuries, infections and lymphoceles• Correct multidetector CT techniques allow identifying haematomas, active bleeding and extravasated urine• Imaging postoperative complications is crucial to assess the need for surgical reoperation
“…The true incidence following pediatric intraperitoneal genitourinary reconstruction or diversion is not known, and comparison to oncologic surgery with pelvic lymph node dissection is not very helpful. Symptomatic intraperitoneal lymphoceles or lymphocysts have developed following cystectomy [15], laparoscopic omentectomy [16], radical hysterectomy [17], retroperitoneal lymph node dissection [12] and abdominal aortic surgery [18].…”
Late, symptomatic abdominopelvic lymphoceles following major pediatric urinary tract reconstruction or diversion develop in <1% patients. Many undergo subsequent abdominopelvic surgery, which may contribute to development of these late, pathologic lymphoceles. Open surgical drainage is usually required with excellent outcome.
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