Current Medical Imaging Reviews, 2007, 3, 277-282 277 1573-4056/07 $50.00+.00 ©2007 Bentham Science Publishers Ltd. Multidetector Computed Tomography of Iatrogenic Urinary Trauma - Pictorial Review Ranka S. Padovan 1,2 , Maja Hrabak 1,2, *, Maja Prutki 1,2 , Marko Kralik 1 , Mario Lusic 1 , Josip Pasini 2,3 , Kristina Potocki 1,2 1 Clinical Institute of Diagnostic and Interventional Radiology, Clinical Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia, 2 University of Zagreb, School of Medicine, Salata 3, 10000 Zagreb, Croatia, 3 Department of Urology, Clinical Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia Abstract: Abdomino-pelvic interventional and surgical procedures can result in iatrogenic urinary tract injury. Radiological diagnosis can be difficult to establish because findings are caused by iatrogenic trauma, and by underlying disease and therapeutical procedures. We performed multidetector computed tomography (MDCT) in patients with suspected urinary tract trauma with scanning protocol selected according to the suspected type of injury: non-enhanced scanning for detection of fluid collections, MDCT angiography for renal parenchymal and vascular changes, MDCT urography for pelvicalyceal and ureteric injuries, and MDCT cystography for bladder and urethral lesions. The injuries were found after urologic, general surgical and gynaecological/obstetric procedures. Renal parenchymal injuries were caused by blunt (extracorporeal shock-wave lithotripsy) or penetrating trauma (renal biopsy), with formation of subcapsular, perinephric and/or paranephric haematomas. Renal vascular pedicle changes after kidney transplantation were precisely defined using MDCT angiography. MDCT urography depicted leakage of contrast material from the pelvicalyceal system after nephron-sparing surgery, from the ureter after kidney transplantation, and from bladder tear after caesarean section, while urethral injury after bladder catheterization was diagnosed using MDCT cystography. MDCT angiography and/or MDCT urography present methods for evaluation of iatrogenic urinary tract trauma because they enable fast and accurate diagnosis and planning of surgical and interventional procedures. Keywords: Iatrogenic disease, urinary tract, multislice computed tomography. INTRODUCTION Urological, abdominal surgical and gynaecological/ obstetric procedures can result in accidental iatrogenic urinary tract trauma and are the commonest cause of ureteric and bladder injury [1]. Renal transplant recipients present the special group of patients with urological complications occurring in 4-8% of cases and vascular complications in 1- 2% of cases [2]. Initially, iatrogenic lesions are usually clinically silent, and therefore associated with delay in diagnosis. Occasionally, they can present with fever, urinary incontinence, loin pain or anuria [3], mostly during first two weeks after the procedure. Because of high morbidity and possible loss of renal function, early detection of urinary tract injury is mandatory. Diagnostic imaging plays a crucial role in prompt identification of the type and site of the injury and enables precise definition of its extent [4]. Traditionally, the diagnosis of urinary tract trauma had been reached by conventional excretory urography, cystography and diagnos- tic intraarterial angiography. Cross-sectional imaging techni- ques, mainly multidetector computed tomography (MDCT), have become preferred methods for early detection of iatro- genic urinary trauma due to their speed, precise definition of urinary tract changes and detection of injuries of other abdominal organs, and relative insensitivity of conventional radiography in this high-risk group of patients [5]. *Address correspondence to this author at the Clinical Institute of Diagnostic and Interventional Radiology, Clinical Hospital Centre Zagreb, University of Zagreb, School of Medicine, Kispaticeva 12, 10000 Zagreb, Croatia; Tel: +38512388455; Fax: +38512388250; E-mail: maja.hrabak@zg.t-com.hr There was no financial interest during conduction of the study. In this paper morphological changes of urinary tract trauma caused by iatrogenic injury rather than accidental injury are described, since they are often more difficult to interpret because they are caused not only by urinary tract trauma, but also by underlying disease, as well as by diag- nostic or therapeutic procedures. To the best of our know- ledge this is the first article dealing with MDCT presen- tations of iatrogenic urinary tract lesions, and depicting optimal scanning protocols for each type of injury. SCANNING PROTOCOLS We retrospectively analyzed MDCT examinations perfor- med during 3-year-period in patients referred to the radio- logical department at tertiary care institution due to suspected urinary tract trauma. All patients underwent urological, gynaecological/obstetric or abdominal surgical procedures at different medical institutions all around the country within one-month period before MDCT exami- nation. Each MDCT examination was done after ultrasono- graphy, which most frequently demonstrated ascites or localized fluid collections. All examinations were performed on MDCT scanner (LightSpeed Ultra 16 Slices per Second, General Electric Medical Systems) from the diaphragmal dome to inguinal regions. The scanning protocol (Table 1) was planned indivi- dually according to the suspected type of injury in order to avoid unnecessary scans and to reduce radiation dose. Non- enhanced scan was performed to detect fluid collections, and diluted iodine contrast material was administered orally if uro-alimentary tract fistulae or communications were suspected. Dual-phase MDCT angiography (MDCTA) was performed to detect renal parenchymal and vascular changes.