Routine annual imaging does not aid in diagnosing new functional complications more than five years after RC with ileal conduit.

Purpose: To assess the value of routine annual imaging in identifying complications more than 5 years after radical cystectomy (RC) with ileal conduit.

Methods: We included patients with bladder cancer who underwent RC with ileal conduit between 2011 and 2018. Patients were excluded if they received no functional follow up after discontinuing oncological follow up, if there was oncological progression or if an uretero-enteric structure (UES) was diagnosed within 5 years after RC. Functional follow up consisted of annual imaging using either ultrasound or CT, along with laboratory tests. The primary outcomes were: (1) the incidence of new or progressive hydronephrosis, and (2) the incidence of imaging-diagnosed complications i.e. UES and urolithiasis.

Results: A total of eighty-two patients were included, with a mean follow up of 6.5 years after RC. In total, 202 ultrasounds and 71 CTs were performed. New or progressive hydronephrosis was observed in 6 imaging modalities (2.2%), in 6 different patients (7.3%). No UES cases were diagnosed following routine annual imaging. One patient was diagnosed with UES after diagnostic imaging was prompted by clinical symptoms.

Conclusion: In our cohort, routine annual imaging beyond five years after radical cystectomy (RC) with ileal conduit rarely revealed abnormalities and did not contribute to the diagnosis of UES nor urolithiasis. However, imaging should be performed when clinically indicated.