The first guide to identifying and assessing changes following urologic surgery-with follow-up protocols What is the normal appearance of a kidney after radio frequency ablation of a tumor and what does a local recurrence look like? How does the urine flow down the ureters after a trans-uretero-ureterostomy? What is the normal appearance of the urinary tract after a cystoplasty? Most clinicians would be hard-pressed to provide answers to such fundamental questions concerning post-surgical anatomy and physiology, and equally challenged to find evidence-based information on the subject.
Most of the literature in radiology and urologic surgery is orientated towards diagnosis and disease management. Although this often includes complications and outcomes, the clinician is often in the dark as to the anatomical and physiological changes that follow successful treatment-especially in cases involving conservative or reconstructive surgery. To rectify this, the editors invited colleagues to share insights gleaned during their careers. The results are contained in Radiology and Follow-up of Urologic Surgery.
Extremely well-illustrated throughout with color photographs and line drawings, Radiology and Follow-up of Urologic Surgery:
Features sections devoted to each of the organs of the genito-urinary tract with chapters covering the major diseases and operations that are used to treat them Focuses on the new normal following surgery with an emphasis on the identification of normal changes versus complications Covers the radiologic changes and biochemical and histological findings which are found following reconstructions Offers guidelines for clinical and radiological follow up after urological surgery in some key areas Radiology and Follow-up of Urologic Surgery is essential reading for surgical residents in urology, as well as radiology residents specializing in urology. It also belongs on the reference shelves of urologists, urological surgeons, obstetric/gynecologic surgeons, and radiologists with an interest in the field, at whatever stage in their career.
Christopher R. J. Woodhouse
, Alex Kirkham
Country of Publication:
03 November 2017
Professional and scholarly
List of Contributors xiii Acknowledgements xv Introduction 1 Christopher Woodhouse and Alex Kirkham 1 Subtotal Nephrectomy and Tumour Ablation 5 David Nicol, Alison Elstob, Christopher Anderson, and Graham Munneke Introduction 5 Procedures 5 Partial Nephrectomy 5 Early Imaging 6 Late Imaging 7 Ablative Therapies 10 Complications 13 Successful Tumour Ablation 14 Treatment Failure 15 Surveillance 18 Follow-up Imaging 18 Partial Nephrectomy 18 Ablative Therapies 19 Surveillance 19 Conclusions 19 References 20 2 Renal Transplantation 23 Rhana H. Zakri, Giles Rottenberg, and Jonathon Olsburgh Introduction 23 The Role of Ultrasound Imaging 23 Vascular Complications 23 Transplant Renal Artery Stenosis 23 Transplant Renal Vein Thrombosis 25 Transplant Renal Artery Thrombosis 26 Arteriovenous Fistula 27 Follow-up 27 Urological Complications 27 Ureteric Complications 28 Anastomotic Urinary Leak or Urinoma 28 Missed Duplex Transplant Ureter 29 Ureteric Stenosis 30 Transplant Ureteric Reflux 30 Bladder Complications 30 Urinary Fistulae 30 General Complications 31 Lymphocoeles 31 Renal Transplant Stone Disease 31 Renal Transplant Trauma 32 Oncological Complications 32 Transplant Renal Cell Carcinoma 32 Transplant Ureteric Transitional Cell Carcinoma 33 Conclusions 33 References 34 3 Imaging After Endo-urological Stone Treatment 37 Daron Smith and Clare Allen Introduction 37 The Procedures 37 Conservative Management 37 Ureteric Stones: Results and Complications 41 Extracorporeal shock wave lithotripsy 41 Ureteroscopy 41 Renal Stones: Results and Complications 44 Flexible Ureterorenoscopy 44 Percutaneous Surgery 46 Complications and Follow-up 48 Residual Fragments After ESWL, URS, FURS and PCNL 48 Radiation Exposure for Patients with Stones 53 References 54 4 Pelvi-ureteric Junction Reconstruction 57 Mohamed Ismail and Hash Hashim Introduction 57 Antenatal Hydronephrosis 57 Pathophysiological Effect of True Pelvi-ureteric Obstruction 58 Physiological and Anatomical Changes in the Kidney Following Pyeloplasty 59 Incidental PUJO in adults 61 Long-term Follow-up 62 Conclusions 63 References 64 5 Retroperitoneal Fibrosis 67 Paul Scheel and Bruce Berlanstein Introduction 67 Available Treatments 67 Medical Therapy 67 Surgical Treatment 69 Follow-up 70 Imaging 70 Stent Removal 70 Complications 71 Stent-related Complications 71 Hydrocoeles 73 Long-term Follow-up 73 Recurrent Disease 74 References 75 6 Urinary Diversion 77 Christopher Woodhouse and Alex Kirkham Introduction 77 The Procedures 77 Clinical Follow-up of Ileal Conduits 78 Postoperative Imaging 78 The `Loopogram' 78 Ultrasound 81 Nephrostomy and Antegrade Imaging 83 Monitoring of Asymptomatic Patients 83 Management of Bacteriuria and Sepsis 84 References 85 7 Ureteric Reconstruction and Replacement 87 Christopher Woodhouse and Aslam Sohaib Introduction 87 Procedures 87 Stents and Nephrostomies 87 Uretero-pyelostomy 87 Uretero-calycostomy 88 Trans-uretero-ureterostomy 88 Ureteric Re-implantation 88 Autotransplantation 90 Intestine 90 Complex Lower Urinary Tract Reconstruction 90 Other Materials and Experimental Techniques 90 Clinical Follow-up and Complications 91 Stents and Nephrostomies 91 Reconstruction with Urothelium 94 Autotransplantation 95 Intestine 96 References 98 8 Conservative and Reconstructive Bladder Surgery 101 Pardeep Kumar Introduction 101 Extravasation 101 Bladder Perforation 101 Reconstruction Following Ureteric Injury and Partial Cystectomy 103 The Irradiated Bladder 106 Complications After Posterior Exenteration 106 Conclusions 107 References 107 9 Bladder Augmentation in Children 109 Paddy Dewan and Padma Rao Introduction 109 The Procedures 109 Augmentation with Ileum or Colon 109 Gastrocystoplasty 109 Seromuscular Cystoplasty 109 Auto-augmentation 110 Uretero-cystoplasty 110 Clinical Follow-up 111 Postoperative Imaging 113 Complications of Enterocystoplasty 115 Metabolic and Electrolyte Disorders (see also Chapter 11) 115 Stones 115 Perforation 117 Neoplastic Progression 118 Unique Complications of Gastrocystoplasty 119 Hypochloraemic Metabolic Alkalosis 119 Hypergastrinaemia 119 Haematuria-Dysuria Syndrome 120 Changes Over Time 120 References 121 10 Radiology and Follow-up of the Neobladder 125 Richard Hautmann and Bjoern G. Volkmer Introduction 125 The Procedure 125 Radical Cystectomy in Females (Figure 10.1) 125 Radical Cystectomy in Males (Figure 10.2) 125 The Neobladder 125 Postoperative Imaging 126 Clinical Follow-up 127 Clinical Examination 127 Bladder and Urine Investigations 128 Renal Investigations 128 Oncologic Follow-up Specific to the Neobladder 132 Local Recurrence 132 Secondary Tumour Growth in Urinary Diversions for Benign Disease (see also Chapter 11) 134 Complications: Lessons Learned from 1000 Neobladders at Ulm 135 Complications up to 90 Days 135 Long-term Complications 135 Changes Over Time 136 Reservoir Control 136 Incontinence 136 Voiding Failure (Hypercontinence) 136 Metabolic Changes (see also Chapter 11) 138 References 138 11 General Consequences of Lower Urinary Tract Replacement and Reconstruction 141 Christopher Woodhouse and Alex Kirkham Introduction 141 Reservoirs 141 The Stomach 141 Ileum 141 Gastrointestinal Consequences 142 Storage Consequences 143 Colon 143 Gastrointestinal Consequences 143 Storage Consequences 143 Rectum 145 Continence (Mainz II) 146 Anastomotic Cancer 147 Urodynamic Findings 149 Stones 149 Renal Function 151 Perforation 151 Histological Changes 153 Infection 155 Neoplasia 156 Urine Testing for Pregnancy 157 The Conduit and Continence 157 References 158 12 Surgery on the Benign Prostate 163 Doug Pendse and Mark R. Feneley Introduction 163 Procedures 163 Outcomes and Complications 165 Postoperative Failure to Void 166 Continued Failure to Void or Unsatisfactory Voiding 166 Sexual Function 168 Incontinence 170 Stricture 170 Unexpected Malignancy 171 Changes Over Time 171 References 172 13 Imaging After Treatment of Prostate Cancer 177 Alex Kirkham Introduction 177 Appearances After Radical Prostatectomy 177 Residual Tumour After Radical Prostatectomy 179 The Prostate After Ablative Therapies 179 Early Appearances 180 Early Complications 181 Appearances at 2-5 Months 182 Appearances at 6 Months: Assessing Residual and Recurrent Tumour 182 Nuclear Medicine Studies 184 A Schedule for Follow-up 184 References 184 14 Urethroplasty 189 Simon Bugeja, Clare Allen, and Daniella E. Andrich Introduction 189 Pericatheter Urethrogram 189 Ascending and Descending Urethrography 190 Radiological Appearance After Different Types of Urethroplasty 191 Traumatic Strictures 192 Idiopathic Bulbar Strictures 193 Penile Urethroplasty 193 Use of Ultrasound in Urethroplasty Follow-up 195 Follow-up After Urethroplasty 196 Radiological Appearance and Surgical Management of Recurrent Strictures After Urethroplasty 197 References 198 15 The Postoperative Appearance and Follow-up of Urinary Tract Prostheses 201 Alex Kirkham Introduction 201 Penile Prostheses 201 Normal Appearance and Imaging Techniques 201 Problems of Positioning and Length 203 Artificial Urinary Sphincters 204 Disorders of Function and Position 205 Infection in Implanted Devices 206 Metallic Stents 208 References 208 Index 211
Christopher Woodhouse, MB, FRCS, FEBU, is an Emeritus Professor of Adolescent Urology at University College London and previously a consultant at the Royal Marsden Hospital. He trained under Sir David Innes Williams at the Institute of Urology and was made Professor of Adolescent Urology at UCL in 2006. He is widely considered as one of the world's leading experts in reconstructive urology and in particular, adolescent urology and congenital urological anomalies. Alex Kirkham, MB BCh, FRCS, FRCR, MD, is a consultant uro-radiologist at University College London Hospitals, London, UK.