Thoeny Harriet C, Studer Urs E, Madersbacher Stephan, Sonnenschein Martin J, Vock Peter
Department of Diagnostic Radiology, University Hospital of Bern, 3010 Bern, Switzerland.
Eur Radiol. 2004 May;14(5):792-7. doi: 10.1007/s00330-003-2218-8. Epub 2004 Feb 17.
The aim of this study was to evaluate the appearance of the upper urinary tract following cystectomy and ileal orthotopic bladder substitution. Intravenous urograms (IVUs) performed preoperatively and at regular intervals postoperatively on 87 long-term survivors (minimum survival, 5 years) following ileal orthotopic bladder substitution were reviewed. Distention of the collecting system with blunted or rounded fornices was defined as dilatation. If in addition contrast medium excretion was delayed on the 5-min film, this was defined as obstruction. Collecting system dilatation was present on all IVU films obtained from most patients (80%) within 6 months of surgery, even in the absence of urinary tract obstruction. In contrast, dilatation was commonly seen only on the 20-min postinjection films (79%) on urograms performed more than 1 year following surgery, but not encountered on the other two postinjection radiographs (at 5 and 60 min). Five years after surgery, permanent obstruction was observed in only five (3%) renoureteral units. Dilatation of the upper urinary tract after ileal orthotopic bladder substitution is a frequent finding on the 5-min, 20-min, and 60-min films during the early postoperative period but is found only on the 20-min film 1 year and later after surgery. These findings should not be overinterpreted as obstruction.
本研究的目的是评估膀胱切除术后回肠原位膀胱替代术后上尿路的表现。回顾了87例回肠原位膀胱替代术后长期存活者（最短存活时间为5年）术前及术后定期进行的静脉肾盂造影（IVU）。集合系统扩张伴穹窿钝圆或圆润被定义为扩张。如果5分钟片上造影剂排泄延迟，则定义为梗阻。大多数患者（80%）术后6个月内所有IVU片上均出现集合系统扩张，即使无尿路梗阻。相比之下，术后1年以上进行的静脉肾盂造影中，扩张通常仅见于注射后20分钟片（79%），而在其他两张注射后X光片（5分钟和60分钟）上未发现。术后5年，仅5个（3%）肾输尿管单位出现永久性梗阻。回肠原位膀胱替代术后早期，5分钟、20分钟和60分钟片上常发现上尿路扩张，但术后1年及以后仅在20分钟片上发现。这些发现不应过度解读为梗阻。
