Late Complication of Orthotopic T-Pouch Ileal Neobladder Diversion

Abstract

A 69-year-old female with history of squamous cell carcinoma of the bladder who underwent anterior pelvic exenteration with an orthotopic T-pouch ileal neobladder 20 years ago was referred to the urology clinic because of worsening renal function. At time of urologic evaluation, the patient was voiding volitionally with a low post-void residual. Despite complete bladder emptying and a fluoroscopic cystogram demonstrating no evidence of reflux, she was recommended by her local urologist to perform clean intermittent catheterization 4-5 times/day, but her renal function continued to deteriorate. Laboratory evaluation revealed a decline in estimated glomerular filtration rate to 29 ml/min/1.73m2 from a baseline of 50 ml/min/1.73m2. A non-contrast computed tomography scan is shown below (Figure) and demonstrated bilateral hydroureteronephrosis and a dilated afferent limb (arrow) of the T-pouch despite a decompressed neobladder (asterisk).