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[The diuresis urogram in patients with a bladder replacement]
E M Merkle1, A J Aschoff, R Bachor
1Abteilung Radiologie I, Universität Ulm.
Rofo : Fortschritte Auf Dem Gebiete Der Rontgenstrahlen Und Der Nuklearmedizin
|November 1, 1996
Summary
A modified furosemide urogram effectively distinguishes significant upper urinary tract obstruction from simple dilation in neobladder patients. This diagnostic tool is well-tolerated and accepted by urologic staff.
Area of Science:
- Urology
- Diagnostic Imaging
Background:
- Neobladder reconstruction can lead to upper urinary tract dilation.
- Differentiating obstruction from non-obstructive dilation is crucial for patient management.
Purpose of the Study:
- To evaluate a modified furosemide urogram for differentiating urodynamically relevant obstruction from functionally unimportant dilation in neobladder patients.
- To assess the diagnostic utility of forced diuresis urography in this population.
Main Methods:
- A modified excretory urogram with furosemide loading was performed in 19 neobladder patients with upper tract dilation.
- Radiographs were taken at 15 and 30 minutes post-furosemide administration to assess contrast medium washout.
- Obstruction was defined by increasing dilation and lack of washout during diuresis.
Main Results:
- Out of 32 dilated renoureteral units (RUU), 25 showed good contrast washout, indicating no significant obstruction.
- Six RUU's had borderline findings, with two requiring surgical intervention for pain.
- One RUU showed decompensated anastomotic stenosis, successfully treated with dilation.
Conclusions:
- The modified furosemide urogram is a cost-effective diagnostic strategy for neobladder patients with upper tract dilation.
- The procedure is well-tolerated and broadly accepted by urologic staff.
- It aids in differentiating significant obstruction from benign dilation, guiding further management.