Alternate approaches to pelvic abscess drainage after cystectomy

Pelvic abscesses and fluid collections are relatively common complications of major pelvic surgery. When a radical cystectomy has been performed, the ultrasonic acoustic window to normal anatomic landmarks is lost and bowel loops prolapse into the anatomic pelvis. This makes standard suprapubic ultrasonography (US) either difficult or nondiagnostic and often obscures significant pathology. The current use of high-frequency endocavitary US transducers permits an alternate view of the remaining pelvic structures. Coronal transgluteal scans also permit a limited view of the presacral area. These approaches were used in drainage of pelvic abscesses after cystectomy using the transrectal, transurethral, transperineal, and transabdominal routes under US guidance.