Routine Retrograde Conduitography after Radical Cystectomy for Bladder Cancer: Diagnostic Yield and Clinical Impact

Despite limited evidence supporting its benefit, postoperative retrograde radiological imaging following radical cystectomy (RC) for bladder cancer is frequently performed prior to ureteral stent removal. The objective of this study was to evaluate the clinical value of routinely performed retrograde conduitography (rCG) after RC with ileal conduit (IC) diversion and to identify potential procedure-related adverse effects.

We retrospectively analyzed 244 patients who underwent RC with IC at the University Hospital of Würzburg between 2012 and 2023. Of these, 116 patients were assigned to the rCG group and 128 to the non-rCG group. Clinical demographics, rCG-related parameters such as radiation dose (dose-area product, DAP), and procedure-related complications were assessed. In addition, data on ureteral stent (MJ) removal without rCG, including associated complications, were collected.

Extravasation at the uretero-intestinal anastomosis was detected by rCG in 6 of 116 patients, all of whom were managed conservatively. The mean radiation dose was 75.52 µGy·m2 (range: 7-797.4 µGy·m2). Twelve rCG-related complications occurred, all urinary tract infections. In the non-rCG cohort, 15 patients experienced complications following MJ removal. There was no significant difference in complication rates between the two groups (15 vs. 12; p = 0.45).

Routine postoperative rCG after RC with IC showed no apparent clinical benefit in this retrospective cohort. The procedure did not reduce complications and was associated with potential harms, including radiation exposure and infection risk. rCG should therefore not be performed routinely but rather reserved for selected, risk-adapted cases.