Abstract
Objective
Radical cystectomy with permanent urinary diversion is the gold standard treatment for invasive muscle bladder cancer. Hydronephrosis is common in these patients, but Ultrasound (US) or Computed Tomography Urography (CTU) scan are unable to discriminate obstructive from non-obstructive hydronephrosis. We used Diuresis Renography (DR) with F + 10 in seated position (sp) method in the identification of patients with a Uretero-ileal Anastomosis Stricture (UAS) who would benefit from surgical therapy.
Methods
We studied 39 asymptomatic patients, who underwent radical cystectomy and urinary diversion. Based on radiological findings (US, CTU) 44 kidneys were hydronephrotic. All patients underwent a 99mTc-MAG3 DR with F + 10(sp) method. We acquired a DR for 20 min with the patient in a seated position. Patient drank 400–500 mL of water at 5 min after tracer injection and received a 20 mg bolus of Furosemide at 10 min during dynamic acquisition. The indices Time to peak, diuretic half time, and 20 min/peak ratio have been evaluated. Retrograde pyelography confirmed UAS in all patients with DR obstructive findings. We repeated DR as follow-up in two subgroups of patients.
Results
DR with F + 10(sp) method showed obstructive findings in 36 out of 44 hydronephrotic kidneys. 6 patients showed non-obstructive findings. 32 patients showed obstructive findings (20 out of 32 developed UAS within 12 months after surgery). Fifteen pts underwent a surgical treatment of UAS. In 1 patient with equivocal findings, we observed an ileo-ureteral reflux.
Conclusions
The DR with F + 10(sp) method in the seated position has a lower uncertain diagnostic rate, compared to the radiological findings of US or CTU, in management of bladder cancer patients with urinary diversion. The semiquantitative indices diuretic half time and 20 min/peak ratio evaluated in a condition of favorable gravity reduce uncertain responses improving interobserver concordance.
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References
Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol. 2001;19(3):666–75. https://doi.org/10.1200/JCO.2001.19.3.666.
Gerharz EW, Hautmann RE, Abol-Enein H, Hafez K, et al. Urinary diversion. Urology. 2008;72(1):231–2.
Bricker EM. Bladder substitution after pelvic evisceration 1950. J Urol. 2002;167:1140–6.
Gore JL, Saigal CS, Hanley JM, Schonlau M, Litwin MS. Urologic diseases in America project variations in reconstruction after radical cystectomy. Cancer. 2006;107(4):729–37.
Lee RK, Abol-Enein H, Artibani W, Bochner B, Dalbagni G, Daneshmand S, et al. Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes. BJU Int. 2014;113(1):11–23. https://doi.org/10.1111/bju.12121.
Hautmann RE, Abol-Enein H, Lee CT, Mansson W, Mills RD, Penson DF, et al. Urinary diversion: how experts divert. Urology. 2015;85(1):233–8. https://doi.org/10.1016/j.urology.2014.06.075.
Amini E, Djaladat H. Long-term complications of urinary diversion. Curr Opin Urol. 2015;25(6):570–7. https://doi.org/10.1097/MOU.0000000000000222.
Ahmed YE, Hussein AA, May PR, Ahmad B, Ali T, Durrani A, et al. Natural history, predictors and management of ureteroenteric strictures after robot assisted radical cystectomy. J Urol. 2017;198(3):567–74. https://doi.org/10.1016/j.juro.2017.02.3339.
Narita T, Hatakeyama S, Koie T, Hosogoe S, Matsumoto T, Soma O, et al. Presence of transient hydronephrosis immediately after surgery has a limited influence on renal function 1 year after ileal neobladder construction. BMC Urol. 2017;17(1):72.
Hashim H, Woose CJ. Ureteropelvic junction obstruction. Eur Urol Suppl. 2012;11:25–32. https://doi.org/10.1016/j.eursup.2012.01.004 (ISSN 1569-9056).
EAU guideline. https://uroweb.org/guideline/bladder-cancer-muscle-invasive-and-metastatic/. Accessed 06 July 2021.
Tartaglione G, D’Addessi A, De Waure C, Pagan M, Raccioppi M, Sacco E, et al. 99mTc-MAG3 diureticrenography in diagnosis of obstructive nephropathy in adults: a comparison between F-15 and a new procedure F+10(sp) in seated position. Clin Nucl Med. 2013;38(6):432–6. https://doi.org/10.1097/RLU.0b013e31828da3f5.
Esteves FP, Taylor A, Manatunga A, Folks RD, Krishnan M, Garcia EV. 99mTc- MAG3 renography: normal values for MAG3 clearance and curve parameters, excretory parameters, and residual urine volume. AJR Am J Roentgenol. 2006;187(6):W610–7. https://doi.org/10.2214/AJR.05.1550.
AIMN. Raccomandazioni procedurali in nefro-urologia: https://www.aimn.it/documenti/lineeguida/8_RP_AIMN_nefro-urologia.pdf. Accessed 06 July 2021.
Lobo N, Dupré S, Sahai A, Thurairaja R, Khan MS. Getting out of a tight spot: an overview of ureteroenteric anastomotic strictures. Nat Rev Urol. 2016;13(8):447–55. https://doi.org/10.1038/nrurol.2016.104.
Oh JJ, Byun SS, Jeong CW, Kwak C, Kim HH, Ku JH. Association Between preoperative hydronephrosis and prognosis after radical cystectomy among patients with bladder cancer: a systemic review and meta-analysis. Front Oncol. 2019;9:158.
Pantuck AJ, Han KR, Perrotti M, Weiss RE, Cummings KB. Ureteroenteric anastomosis in continent urinary diversion: long-term results and complications of direct versus non-refluxing techniques. J Urol. 2000;163(2):450–5. https://doi.org/10.1016/s0022-5347(05)67898-6.
Shah SH, Movassaghi K, Skinner D, Dalag L, Miranda G, Cai J, et al. Ureteroenteric strictures after open radical cystectomyand urinary diversion: the university of southern california experience. Urology. 2015;86(1):87–91. https://doi.org/10.1016/j.urology.2015.03.014.
De Nunzio C, Cindolo L, Leonardo C, Antonelli A, Ceruti C, Franco G, et al. Analysis of radical cystectomy and urinary diversion complications with the Clavien classification system in an Italian real-life cohort. Eur J Surg Oncol. 2013;39(7):792–8. https://doi.org/10.1016/j.ejso.2013.03.008.
Jinzaki M, Yamada Y, Nagura T, Nakahara T, Yokoyama Y, Narita K, et al. Development of upright computed tomography with area detector for whole- body scans: phantom study, efficacy on workflow, effect of gravity on human body, and potential clinical impact. Invest Radiol. 2020;55(2):73–83. https://doi.org/10.1097/RLI.0000000000000603.
Loran OB, Mudraia IS, David’iants AA, Zaĭtsev AV. Urodynamics of upper urinary tracts after intestinal plastic surgery on urinary bladder (experimental study)]. Urologiia. 1999;4:17–21.
Gordon I, Piepsz A, Sixt R. Auspices of paediatric committee of european association of nuclear medicine guidelines for standard and diuretic renogram in children. Eur J Nucl Med Mol Imaging. 2011;38(6):1175–88. https://doi.org/10.1007/s00259-011-1811-3.
Rossleigh MA, Leighton DM, Farnsworth RH. Diuresis renography The need for an additional view after gravity-assisted drainage. Clin Nucl Med. 1993;18(3):210–3.
Piepsz A, Tondeur M, Ham H. NORA: a simple and reliable parameter for estimating renal output with or without frusemide challenge. Nucl Med Commun. 2000;21(4):317–23. https://doi.org/10.1097/00006231-200004000-0000.
Tondeur M, De Palma D, Roca I, Piepsz A, Ham H. Inter-observer reproducibility in reporting on renal drainage in children with hydronephrosis: a large collaborative study. Eur J Nucl Med Mol Imaging. 2008;35(3):644–54. https://doi.org/10.1007/s00259-007-0641-9.
EANM. Dynamic renal imaging in obstructive renal pathology. https://www.eanm.org/content-eanm/uploads/2016/11/tech_dynamic.pdf. Accessed 06 July 2021.
Taylor AT. Radionuclides in nephrourology, Part 2: pitfalls and diagnostic applications. J Nucl Med. 2014;55(5):786–98. https://doi.org/10.2967/jnumed.113.133454.
Tartaglione G, Townsend DM, Bassi PF, Delgado Bolton RC, Giammarile F, Rubello D. Diuresis renography in equivocal urinary tract obstruction. A historical perspective. Biomed Pharmacother. 2019;116: 108981. https://doi.org/10.1016/j.biopha.2019.108981Accessed15September2020.
Taylor AT, Brandon DC, De Palma D, Blaufox MD, Durand E, Erbas B, et al. SNMMI procedure standard/eanm practice guideline for diuretic renal scintigraphy in adults with suspected upper urinary tract obstruction. Semin Nucl Med. 2018;48(4):377–90.
Catalá V, Solà M, Samaniego J, Martí T, Huguet J, Palou J, et al. CT findings in urinary diversion after radical cystectomy: postsurgical anatomy and complications. Radiographics. 2009;29(2):461–76. https://doi.org/10.1148/rg.292085146.
Perazella MA. Gadolinium-contrast toxicity in patients with kidney disease: nephrotoxicity and nephrogenic systemic fibrosis. Curr Drug Saf. 2008;3(1):67–75. https://doi.org/10.2174/157488608783333989.
Schöndorf D, Meierhans-Ruf S, Kiss B, Giannarini G, Thalmann GN, Studer UE, et al. Uretero ileal strictures after urinary diversion with an ileal segment-is there a place for endourological treatment at all? J Urol. 2013;190(2):585–90. https://doi.org/10.1016/j.juro.2013.02.039.
Katherine AA, Emily AV, Gillian S, Ali F, Daniel DS, Machele SD, et al. Predictors of benign uretero-enteric anastomotic strictures after radical cystectomy and urinary diversion. Urology. 2018. https://doi.org/10.1016/j.urology.2018.06.024.
van de Putte FEE, de Wall LL, van Werkhoven E, Heldeweg EA, Bex A, van der Poel HG, et al. Endo-urological techniques for benign uretero-ileal strictures have poor efficacy and affect renal function. Urol Int. 2018;100(1):18–24.
Tartaglione G, Foschi N, Recupero SM, Ieria FP, Tarantino G, Bassi P. Advantages of gravity-assisted diuretic renogram: F + 10 (seated position) method. Nucl Med Commun. 2021;42(6):602–10. https://doi.org/10.1097/MNM.0000000000001378.
Barber NJ, Thompson PM. Nephroptosis and nephropexy–hung up on the past? Eur Urol. 2004;46(4):428–33. https://doi.org/10.1016/j.eururo.2004.03.023.
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Tartaglione, G., Foschi, N., Ragonese, M. et al. A gravity-assisted approach to the management of urinary diversion: 99mTc-MAG3 diuresis renography with F + 10(sp) method. Ann Nucl Med 35, 1127–1135 (2021). https://doi.org/10.1007/s12149-021-01648-x
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DOI: https://doi.org/10.1007/s12149-021-01648-x