AI Article Synopsis
- Radical cystectomy with permanent urinary diversion is the standard treatment for invasive bladder cancer, but distinguishing between obstructive and non-obstructive hydronephrosis can be challenging with traditional imaging methods like Ultrasound (US) and Computed Tomography Urography (CTU).
- Using Diuresis Renography (DR) with the F + 10 seated method on 39 patients, researchers were able to identify those with Uretero-ileal Anastomosis Strictures (UAS), which indicated a need for surgical intervention.
- The results revealed that DR significantly reduced diagnostic uncertainty; 36 out of 44 hydronephrotic kidneys showed obstructive findings, leading to targeted treatments for UAS and better management strategies for
Article Abstract
Objective: Radical cystectomy with permanent urinary diversion is the gold standard treatment for invasive muscle bladder cancer. Hydronephrosis is common in these patients, but Ultrasound (US) or Computed Tomography Urography (CTU) scan are unable to discriminate obstructive from non-obstructive hydronephrosis. We used Diuresis Renography (DR) with F + 10 in seated position (sp) method in the identification of patients with a Uretero-ileal Anastomosis Stricture (UAS) who would benefit from surgical therapy.
Methods: We studied 39 asymptomatic patients, who underwent radical cystectomy and urinary diversion. Based on radiological findings (US, CTU) 44 kidneys were hydronephrotic. All patients underwent a Tc-MAG3 DR with F + 10(sp) method. We acquired a DR for 20 min with the patient in a seated position. Patient drank 400-500 mL of water at 5 min after tracer injection and received a 20 mg bolus of Furosemide at 10 min during dynamic acquisition. The indices Time to peak, diuretic half time, and 20 min/peak ratio have been evaluated. Retrograde pyelography confirmed UAS in all patients with DR obstructive findings. We repeated DR as follow-up in two subgroups of patients.
Results: DR with F + 10(sp) method showed obstructive findings in 36 out of 44 hydronephrotic kidneys. 6 patients showed non-obstructive findings. 32 patients showed obstructive findings (20 out of 32 developed UAS within 12 months after surgery). Fifteen pts underwent a surgical treatment of UAS. In 1 patient with equivocal findings, we observed an ileo-ureteral reflux.
Conclusions: The DR with F + 10(sp) method in the seated position has a lower uncertain diagnostic rate, compared to the radiological findings of US or CTU, in management of bladder cancer patients with urinary diversion. The semiquantitative indices diuretic half time and 20 min/peak ratio evaluated in a condition of favorable gravity reduce uncertain responses improving interobserver concordance.
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| http://dx.doi.org/10.1007/s12149-021-01648-x | DOI Listing |
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