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A gravity-assisted approach to the management of urinary diversion: 99mTc-MAG3 diuresis renography with F + 10(sp) method

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Abstract

Objective

Radical cystectomy with permanent urinary diversion is the gold standard treatment for invasive muscle bladder cancer. Hydronephrosis is common in these patients, but Ultrasound (US) or Computed Tomography Urography (CTU) scan are unable to discriminate obstructive from non-obstructive hydronephrosis. We used Diuresis Renography (DR) with F + 10 in seated position (sp) method in the identification of patients with a Uretero-ileal Anastomosis Stricture (UAS) who would benefit from surgical therapy.

Methods

We studied 39 asymptomatic patients, who underwent radical cystectomy and urinary diversion. Based on radiological findings (US, CTU) 44 kidneys were hydronephrotic. All patients underwent a 99mTc-MAG3 DR with F + 10(sp) method. We acquired a DR for 20 min with the patient in a seated position. Patient drank 400–500 mL of water at 5 min after tracer injection and received a 20 mg bolus of Furosemide at 10 min during dynamic acquisition. The indices Time to peak, diuretic half time, and 20 min/peak ratio have been evaluated. Retrograde pyelography confirmed UAS in all patients with DR obstructive findings. We repeated DR as follow-up in two subgroups of patients.

Results

DR with F + 10(sp) method showed obstructive findings in 36 out of 44 hydronephrotic kidneys. 6 patients showed non-obstructive findings. 32 patients showed obstructive findings (20 out of 32 developed UAS within 12 months after surgery). Fifteen pts underwent a surgical treatment of UAS. In 1 patient with equivocal findings, we observed an ileo-ureteral reflux.

Conclusions

The DR with F + 10(sp) method in the seated position has a lower uncertain diagnostic rate, compared to the radiological findings of US or CTU, in management of bladder cancer patients with urinary diversion. The semiquantitative indices diuretic half time and 20 min/peak ratio evaluated in a condition of favorable gravity reduce uncertain responses improving interobserver concordance.

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Acknowledgements

None of the authors has a conflict of interest relatively to the topic of this article.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Cristo Re Hospital, 25 Via delle, Calasanziane, 00167, Rome, Italy

    Girolamo Tartaglione & Francesco P. Ieria

  2. Department of Urology, A. Gemelli Hospital IRCCS—Catholic University of Sacred Heart, Rome, Italy

    Nazario Foschi, Mauro Ragonese & Pierfrancesco Bassi

  3. Department of Urology, Fatebenefratelli San Giovanni Calibita Hospital, Rome, Italy

    Salvatore M. Recupero

  4. Catholic University of Sacred Heart, Rome, Italy

    Giulio Tarantino

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  1. Girolamo Tartaglione
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Correspondence to Girolamo Tartaglione.

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Tartaglione, G., Foschi, N., Ragonese, M. et al. A gravity-assisted approach to the management of urinary diversion: 99mTc-MAG3 diuresis renography with F + 10(sp) method. Ann Nucl Med 35, 1127–1135 (2021). https://doi.org/10.1007/s12149-021-01648-x

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