Selective Postoperative Imaging After Ureteroscopy

• Published in: Urology (Ridgewood, N.J.) N.J.), 2009-03, Vol.73 (3), p.490-493
• Main Authors: Adiyat, Kishore Thekke, Meuleners, Rachel, Monga, Manoj
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Kidney Calculi - surgery; Male; Middle Aged; Postoperative Complications - diagnostic imaging; Retrospective Studies; Tomography, X-Ray Computed; Ureteral Calculi - surgery; Ureteral Obstruction - diagnostic imaging; Ureteroscopy; Urology; Young Adult
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2008.09.064

Objectives To evaluate the need of routine follow-up imaging after ureteroscopy. Methods We performed a retrospective chart review of patients undergoing ureteroscopy for urolithiasis. Selective imaging was performed in the initial postoperative phase (1-3 weeks after removal of the ureteral stent) if the procedure was classified as complicated because of the presence of an impacted stone, the need for balloon dilation, intraoperative ureteral perforation, or postoperative pain after stent removal. Uncomplicated ureteroscopy was followed by repeat imaging if the patient developed recurrent renal colic or as surveillance for new stone growth at 6-12 months of follow-up. Results A total of 267 ureteroscopic procedures were performed on 253 patients. The data from 214 of 253 patients (84.6%) who had undergone noncontrast-enhanced computed tomography imaging ≥1 month after surgery were analyzed. The mean follow-up was 14.5 months (range 1-66). The incidence of stricture was 1.4% (3/214). The incidence in the selective imaging (complicated ureteroscopy) group was 5.3% (3/56). In uncomplicated ureteroscopy group, it was 0% (0/158). Ureteral stricture developed in 3 of 11 patients with stone impaction (27.2%, P = .002), 2 of 14 patients undergoing ureteral balloon dilation (10.4%, P = .0052), and in 1 of 6 patients with an intraoperative mucosal perforation (16.6%, P = .0326). Persistent postoperative pain after stent removal was not predictive of stricture formation (3.6%, P = .139). Conclusions The results of our study have shown that selective imaging as determined by the intraoperative findings of complicated ureteroscopy (eg, impacted stone, balloon dilation, mucosal perforation) will detect postoperative ureteral strictures. Routine follow-up imaging is not essential after uncomplicated ureteroscopy.