Cheryl A. Sadow MD, Presenter: Nothing to Disclose

Stuart George Silverman MD, Abstract Co-Author: Consultant, Galil Medical Ltd, Yokneam, Israel Consultant, Siemens AG

Controversy exists about how to follow patients after cystectomy for bladder cancer as these patients have a 5% risk of upper tract cancers. Our study sought to determine the utility of CT urography as the imaging modality for follow-up of patients who have undergone cystectomy for bladder cancer.

CT urograms performed at our institution from May 2000 through October 2005 were retrospectively reviewed. CT urograms performed in patients with prior cystectomy for urothelial cancer were analyzed for radiologic findings related to the urinary tract or the primary bladder malignancy. Clinical follow up was used as the gold standard with all patients having at least 6 months of follow-up and 83% having at least 1 year of follow-up.

Ninety patients had 121 CT urograms performed after cystectomy. Of these, 25 patients (28%) had a finding relevant to the urinary tract or the prior bladder cancer. However, 14 of these 25 patients had either suspected lymph node metastases or local tumor recurrence which could have been evaluated on standard CT scans of the abdomen and pelvis. Of the remaining 11 patients, 4 had findings which warranted intervention: 1 upper tract cancer, 2 ureteral leaks, and 1 obstructing ureteral stone. Only the two ureteral leaks required CT urography for visualization and both were suspected clinically prior to imaging. The one upper tract tumor was a caliceal lesion first detected on routine CT scan of the abdomen and confirmed with CT urography. One case needing intervention was seen immediately post-operatively (2 days) and one was seen more than 3 years after cystectomy.

Of the 90 patients imaged with CT urography after cystectomy for bladder cancer, only 1 upper tract cancer was detected. The incidence of upper tract cancers was lower than expected in our patient population, suggesting routine follow-up with CT urography may be unwarranted. This test was most useful in evaluating suspected ureteral injury or radiographically suspected urothelial lesions.

The risk of metastatic disease or local recurrence after cystectomy for bladder cancer is high, but the low incidence of metachronous upper tract tumors favors standard CT rather than CT urography.

Sadow, C, Silverman, S, Upper tract Imaging in Patients Status: Post Cystectomy for Bladder Cancer—When and How to Image?.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5006182.html