Postoperative Complications in Urinary Diversion: The Value of Computed Tomography in Clinical Management

Background/Objectives: This study aimed to evaluate the diagnostic accuracy of computed tomography (CT) in detecting postoperative complications following reconstructive urinary diversion. Methods: We retrospectively analyzed 151 patients (2004–2024) who underwent urinary diversion and required abdominal CT within 30 days postoperatively due to a complicated course. CT accuracy for detecting intestinal anastomotic leakage, urinoma, and hemorrhage was assessed against the composite reference standard of final clinical diagnosis. Predictive values of imaging, clinical signs, and laboratory markers were evaluated using logistic regression and ROC analyses. Results: CT demonstrated low sensitivity for intestinal leakage (33.3%), hemorrhage (50.0%), and urinoma (60.7%). However, specificity (>87%) and negative predictive values (>88%) were high for intestinal leakage, urinoma, and hemorrhage. In exploratory multivariable analyses, positive CT findings were strongly associated with intestinal leakage, hemorrhage, and urinoma. Valuable adjuncts included abdominal guarding for intestinal leakage and serum creatinine dynamics for urinoma. Conversely, general inflammatory markers (CRP, leukocytes) and hemoglobin levels failed to reliably discriminate specific complications. Conclusions: Abdominal CT stands out from clinical or laboratory parameters but lacks the sensitivity required for reliable primary detection of major complications. A negative scan should not provide false reassurance in a deteriorating patient. Effective clinical management requires an integrative approach, combining CT findings with physical examination and targeted laboratory trends rather than relying on non-specific inflammatory markers.