The diuresis urogram in patients with a bladder replacement

Abstract

To differentiate between urodynamically relevant obstruction and functionally unimportant dilation of the upper urinary tract in patients with neobladder using a modified furosemide urogram. An excretory urogram with furosemide loading was carried out in 19 patients with neobladder and sonographically and urographically confirmed dilation of the upper urinary tract. Once strong contrasting of the renal pelves and calyces has been achieved, 20 mg of furosemide were applied and late radiographs were obtained at 15 min and 30 min, respectively. An obstruction was defined as increasing dilation of the renal pelves and calices during forced diuresis and lack of washout effect of the contrast medium. In 32 cases, the renoureteral unit (RUU) was dilated on ultrasound. Of these, 25 RUU's showed good emptiness of contrast medium upon stimulation of diuresis, six RUU's returned a borderline findings, while one RUU was found to exhibit a decompensated anastomotic stenosis, which was dilated. Two further patients with borderline findings were later treated surgically due to their pain symptoms. No patient required further preoperative diagnostic procedures. The modified furosemide urogram represents a cost-effective diagnostic orientation strategy in patients with neobladder and dilated renal pelves and calyces and is both well-tolerated by patients and meets with broad acceptance from the urologic staff.