Three-dimensional computed tomography of the orthotopic ileal neobladder reconstruction: normal and abnormal findings

Our study aimed to assess the usefulness of 3D-CT in patients who have undergone radical cystectomy and orthotopic ileal neobladder.

We performed a CT study with 3D reconstructions in 32 patients 6 months after radical cystectomy and different orthotopic ileal neobladder (8 Studer, group A; 10 Hautmann-Ghoneim, group B; 14 Hautmann with 'double chimney' modification, group C). We evaluated position, shape and volume of neobladder; length of ureters and of afferent limb (in group A), length and diameter of ureteral intramural tunnel (in group B) and length of 'chimney' (in group C); vesico-urethral angle; vesico-ureteral reflux; possible complications.

In group A, we observed a renal stone with hydronephrosis, a lateral neobladder and a bilateral vesico-ureteral reflux. In 2 females of group B, neobladder was on the right side and associated in 1 case with a conical shape, hydroureteronephrosis, filling defects and urinary incontinence. In group C, 1 patient had a bilateral vesico-ureteral reflux and 1 had a left hydronephrosis. A pouchocele was detected in 1 patient with vesico-urethral angle less than 120 degrees.

3D-CT is helpful for better displaying the morphology of a new reno-vesical anatomy, and some features seem to be indicative of a predisposition to develop possible complications. It may be useful for surgeons to plan a reintervention to obviate or prevent complications.