Assisted Virtual Cystoscopy in the Condition of Retrograde CT Cystography in Patients with Chronic Kidney Disease

Abstract

Virtual CT cystoscopy is an imaging method that allows assessing of bladder wall for possible intraluminal formations. It can give a preliminary idea about the number, size and location of the lesions and their relationship to the bladder wall. The most common method of virtual cystoscopy is to apply contrast material intravenously and follow its excretion. However, this method is not applicable in patients with chronic kidney disease (CKD). For this reason we have developed and introduced for the first time in our country an alternative method suitable for this group of patients. It is based on the homogeneous filling of the bladder with a contrast agent during preliminary catheterization, thanks to which quality images are obtained – assisted virtual cystoscopy in conditions of CT cystography. A total of 44 patients with hematuria underwent assisted virtual cystoscopy during retrograde CT cystography: as a primary examination in 35 cases (79.5%) and as a control study in 9 patients (20.5%) with a history of proven superficial non-muscle invasive bladder cancer. From the performed conventional urethrocystoscopy in 12 patients (27%) formations ≤ 4 mm were found, which did not have a specific diagnostically significant CT image. In 32 patients (73%) formations greater than ≥ 4 mm in diameter were observed and it was found that there is 100% coincidence in terms of location, shape and the dimensions of the volumetric process. Assisted virtual cystoscopy in retrograde CT cystography is a method with good diagnostic results in patients with CKD and hematuria of bladder origin.