[Cystectomy and internal urinary diversion in bladder neoplasm. Role of CT in the follow-up]. / Cistectomia e diversione urinaria interna per neoplasia vescicale. Ruolo della TC nel follow-up.

Fifty-seven patients, with prior cystectomy and continent urinary diversion for transitional cell carcinoma of the bladder, were evaluated with CT. Forty-two of them presented ureterosigmoidostomy and 15 orthotopic ileal bladder. The CT appearance of the normal post-cystectomy pelvis is emphasized. Both early and late surgical and neoplastic complications were detected. Early surgical complications, including urinary fistulae, urinomas, seromas, lymphoceles, and abscesses, were diagnosed over a 6-month postoperative period. Late surgical complications included hydroureteronephrosis, calculosis, and pyelonephritis. Hydroureteronephrosis, due to stenosis of the ureteral anastomosis, was the most frequent complication. All such neoplastic complications as local recurrence, lymphnode distant metastases, were identified. In 83% of cases they were observed over a 2-year postoperative period. Distant metastases in the upper abdomen were never detected. The authors' experience suggests the following as the optimal follow-up: a) CT examination over a 6-month postoperative period; b) yearly CT examinations and urography over 4 postoperative years; c) yearly US examination over the first 2 years after surgery, to depict renal pelvis dilatation. Skeletal scintigraphy is often necessary to detect metastatic bone lesions. It should be performed no later than 2 years after cystectomy.