Loopography after ileal conduit urinary diversion – a useful investigation?

Abstract

Purpose A loopogram has historically been used to demonstrate the anatomy and patency of the ureteroileal anastomosis following ileal conduit urinary diversion. We review the place of routine postoperative loopography and other imaging modalities in the assessment of asymptomatic ureteroileal conduit obstruction. Methods and materials An audit of all routine loopograms over a period of five years (December 2008 to June 2013) to diagnose asymptomatic ureteroileal obstruction following radical cystectomy and ileal conduit formation using the Wallace refluxing technique. Results A total of 47 loopograms were performed in 90 renal units between six to 12 weeks postoperatively. Of these, 82 renal units showed free reflux while eight units had no or slow reflux. Subsequent computed tomography (CT) urogram revealed that only one or the non/slow refluxing units was obstructed. Conclusion We conclude that postoperative loopography is a useful to demonstrate anatomy and show contrast leak but insensitive in the diagnosis of asymptomatic ureteroileal obstruction. We propose routine follow-up with ultrasound at three months to detect asymptomatic obstruction and a six monthly cancer follow-up CT scan.