Selective Postoperative Imaging After Ureteroscopy

Adiyat, Kishore Thekke; Meuleners, Rachel; Monga, Manoj

doi:10.1016/j.urology.2008.09.064

Cited by 48 publications

(14 citation statements)

References 16 publications

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“…Various groups have reported post-ureteroscopy stricture rates ranging from 0-4% of all ureteroscopies. [10][11][12] Because ureteric strictures can develop even after seemingly uncomplicated endoscopic treatment of urolithiasis, an important consideration is whether or not routine postoperative imaging is needed following all ureteroscopies.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of risk factors and treatment options in patients with ureteral stricture disease at a single institution

Tran¹,

Arsovska

Paterson

et al. 2015

CUAJ

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Introduction: Ureteral strictures are a significant cause of morbidity and mortality, resulting in potential kidney damage requiring several surgical procedures. Non-malignant causes include radiation, trauma from calculi impaction, pelvic surgery, or ureteroscopy (URS). We identified risk factors in our patients with ureteral strictures and the success of their treatment outcomes. Methods: A retrospective chart review of 25 patients with 29 ureteral strictures was performed to determine the success of their treatment. Results: Twenty-five (25) patients with 29 benign ureteral strictures were identified. Most cases (60%) were caused by impacted stones where the median stone size was 1.15 cm (0.37-1.8 cm). Intervention for stones prior to stricture development included shockwave lithotripsy, URS, and percutaneous nephrolithotomy. Five patients with strictures from impacted stones had ureteric complications during stone treatment including perforation +/-urinoma (n=3), fractured guidewire left in situ (n=1), and ureteric orifice resection (n=1). Other stricture etiologies included radiation (28%) and endometriosis (4%). Treatment modalities used included ureteroureterostomy (n=2), ureteral re-implant (n=3), urinary diversion (n=3), autotrasplant (n=1), laser endoureterotomy +/-balloon dilation (n=8), nephrectomy (n=2), balloon dilation +/-stent (n=3), ureterovesical junction (UVJ) resection + stent (n=1), chronic stent changes (n=4), or surveillance (n=3). Conclusions: Our evaluation highlights important principles. Patients with complicated ureteroscopies or severely impacted calculi warrant close followup with imaging after stone treatment due to possibility of rapid renal deterioration from stricture formation. Radiation-induced strictures are difficult to manage, possibly requiring subsequent urinary diversion. Finally, endoscopic management of benign ureteral strictures via balloon dilation and laser endoureterotomy is an excellent choice in properly selected patients, with opportunity for subsequent salvage treatments if needed.

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Section: Discussionmentioning

confidence: 99%

“…11 He examined 214 patients with renal and ureteral calculi treated with ureteroscopy. All had CT KUB ≥1 month post-ureteroscopy.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of risk factors and treatment options in patients with ureteral stricture disease at a single institution

Tran¹,

Arsovska

Paterson

et al. 2015

CUAJ

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“…Demographic, stone-related and operative characteristics were collected including age, gender, stone size, localization and multiplicity, history of ipsilateral URS, presence, and duration of stone impaction (defined based on previous study, as time interval from preoperative imaging showing hydronephrosis until time of surgical intervention) [13] , pre-URS hydronephrosis, duration of operation, ureteral dilation, stone extraction, post-procedural stent implantation, intraoperative complication, presence of residual stone after the operation, ureteral stent placement, duration of ureteral stent, symptomatic episode and presence, and etiology of postoperative hydronephrosis.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore routine postoperative imaging following URS, is also under debate. [11][12][13][14] To date, selective postoperative imaging for patients with higher risk of developing ureteral obstruction seems to be reasonable due to cost and side effects (radiation exposure) of imaging modalities. [13] Ultrasonography or non-contrast computerized tomography (CT) can be used as an imaging modality, but the latter has become the standard for diagnosing acute flank pain, with sensitivity of 97% and specificity of 95% in patients with urolithiasis.…”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13][14] To date, selective postoperative imaging for patients with higher risk of developing ureteral obstruction seems to be reasonable due to cost and side effects (radiation exposure) of imaging modalities. [13] Ultrasonography or non-contrast computerized tomography (CT) can be used as an imaging modality, but the latter has become the standard for diagnosing acute flank pain, with sensitivity of 97% and specificity of 95% in patients with urolithiasis. [15,16] In this study, we aimed to determine the incidence of ipsilateral hydronephrosis and factors associated with development of ipsilateral hydronephrosis in a cohort of patients who underwent URS for ureteral stone and postoperative non-contrast CT.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of postoperative hydronephrosis following semirigid ureteroscopy: Incidence and predictors

Gökçe

Esen

Gülpınar

et al. 2017

Turkish Journal of Urology

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Objective: Hydronephrosis developing following ureteroscopy (URS) is an important issue associated with the long-term postoperative renal functions. Studies investigating the role of postoperative imaging revealed conflicting results. In this study, we aimed to determine the incidence and predictors of hydronephrosis following semirigid URS. Material and methods:We evaluated the results of 455 patients who underwent URS and postoperative imaging with non-contrast computed tomography (CT). Primary endpoints of the study were to determine the frequency of development of hydronephrosis and factors associated with the development of hydronephrosis. Logistic regression analysis was used to define factors effecting on the development of hydronephrosis.Results: Postoperative non-contrast CT revealed hydronephrosis in 81 (17.8%) patients. Stone-free status was achieved in 415 (91.2%) patients. Univariate analysis revealed history of ipsilateral URS (p= 0.001), duration of operation (p=0.022), presence of multiple stones (p=0.001), and occurrence of a renal colic episode postoperatively (p=0.013) as the parameters associated with increased risk of postoperative hydronephrosis. In the multivariate analysis, history of ipsilateral URS (OR: 2.724, p=0.017) and presence of multiple stones (OR: 2.116, p=0.032) were found to be the independent prognostic markers of developing postoperative hydronephrosis. Conclusion:Ipsilateral hydronephrosis following URS develops in a significant number of patients. In patients with history of ipsilateral hydronephrosis and multiple stones, risk of development of postoperative hydronephrosis is higher, therefore physicians should be keep these parameters in mind in the decision making process of selective imaging postoperatively.

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Management of Complications Associated with Various Lithotripsy Techniques

Cottrell

Dickinson

2014

Urinary Stones

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Selective Postoperative Imaging After Ureteroscopy

Cited by 48 publications

References 16 publications

Evaluation of risk factors and treatment options in patients with ureteral stricture disease at a single institution

Evaluation of risk factors and treatment options in patients with ureteral stricture disease at a single institution

Evaluation of postoperative hydronephrosis following semirigid ureteroscopy: Incidence and predictors

Management of Complications Associated with Various Lithotripsy Techniques

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