Ileal conduit

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An ileal conduit (or "Bricker conduit") was one of the original types of urinary diversions, and it is still in use today.

Pathology

The conduit is most often placed after cystectomy (or cystoprostatectomy) for muscle-invasive bladder cancer. Although not a continent diversion, it may be preferred if the patient will have trouble self-catherising and maintaining a continent urinary diversion.

The conduit is formed from 15-20 cm of ileum. The ureters are anastomosed/spatulated to the upstream loop of ileum and the downstream loop is brought to the skin surface as an ostomy. The ileal loop continues to peristalse.

Radiographic features

Reasons for why an ileal conduit may need to be imaged include:

  • early postoperative: if there is concern for an anastomotic leak
  • late:
    • if there is concern for a ureteroileal stricture causing urinary tract obstruction
    • if the ileal conduit has been complicated by calculus formation
    • to assess for possible tumor recurrence
    • if there is concern for stricture of the ileal loop itself

Ileal conduits are most often imaged with CT urography (CTU) or through retrograde urography (loopogram). Both approaches have their benefits and disadvantages.