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Sonography of the bladder after ureteral reimplantation
J M Zerin1, J D Smith, J K Sanvordenker
1Section of Pediatric Radiology, University of Michigan Hospitals, Ann Arbor 48109-0252.
Insights
Focal thickening of the posterior bladder wall is common after ureteral reimplantation in children. This finding, often seen early post-surgery, can represent edema, fibrosis, or granuloma formation.
Area of Science:
- Pediatric Urology
- Diagnostic Imaging
- Surgical Outcomes
Background:
- Ureteral reimplantation is a common procedure in pediatric urology.
- Postoperative changes in the bladder wall can occur following this surgery.
- Sonography is frequently used for follow-up assessment.
Purpose of the Study:
- To evaluate the incidence, characteristics, and temporal evolution of focal thickening of the posterior bladder wall and bladder base after ureteral reimplantation in children.
- To determine if sonographic findings can differentiate between postoperative edema and other causes of thickening.
Main Methods:
- Retrospective review of pre- and postoperative sonograms.
- Analysis of 59 children undergoing ureteral reimplantation.
- Assessment of thickening frequency, location, extent, and evolution over time.
Main Results:
- Focal thickening of the posterior bladder wall and trigone was observed in 54.2% of patients.
- Thickening was more frequent with earlier sonographic evaluation post-reimplantation.
- Common findings included fusiform thickening along the submucosal tunnel (13 patients) and hyperechoic nodules at the trigone (24 patients).
- Thickening resolved in one-third of cases, presumed to be edema.
Conclusions:
- Focal posterior bladder wall thickening is a frequent sonographic finding after pediatric ureteral reimplantation.
- Early postoperative sonography reveals thickening more often.
- Sonographic appearance alone cannot reliably distinguish between transient edema and developing fibrosis or granuloma.
Abstract:
Pre- and postoperative sonograms were reviewed in 59 children who underwent ureteral reimplantation to assess the frequency, location, extent, and evolution over time of focal thickening of the posterior bladder wall and bladder base after reimplantation. The interval between reimplantation and follow-up sonography ranged from 2 weeks to 12.36 years (mean, 1.29 years). Thirty-two patients (54.2%) had focal thickening of the posterior bladder wall and trigone after reimplantation. The earlier after reimplantation the children were first evaluated with sonography, the much more frequently was thickening observed. Thirteen had fusiform thickening along the submucosal tunnel and twenty-four had a hyperechoic nodule at the trigone. The thickening resolved in one third of the children and is presumed to have represented postoperative edema in these cases. However, on the sonographic appearance alone it was not possible to differentiate transient changes resulting from postoperative edema from those representing developing fibrosis or granuloma formation.