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Is there a benefit from routine voiding cystourethrography after ureterocystoneostomy?
L P Hegi1, B P Geffken, B Hanimann
1Department of Paediatrics, Kantonsspital Winterthur, Winterthur, Switzerland. lukas.hegi@ksw.ch
Summary
Routine voiding cystourethrography (VCUG) after ureterocystoneostomy (UCN) surgery for pediatric urinary issues offers limited benefit. Clinical and ultrasound follow-ups are sufficient, reserving VCUG for cases with suspected complications.
Area of Science:
- Pediatric Surgery
- Urology
- Diagnostic Imaging
Background:
- Surgical repair, including ureterocystoneostomy (UCN), is standard for pediatric vesicoureteral reflux (VUR) and primary obstructive megaureter (POM) post-conservative therapy failure.
- Postoperative voiding cystourethrography (VCUG) is commonly used to detect persistent reflux but incurs radiation exposure, patient discomfort, and costs.
Purpose of the Study:
- To evaluate the clinical benefit of routine postoperative voiding cystourethrography (VCUG) following ureterocystoneostomy (UCN).
- To assess the impact of VCUG on radiation exposure, patient discomfort, and healthcare costs in pediatric surgical patients.
Main Methods:
- Retrospective review of medical records for 81 pediatric patients (126 renal units) who underwent ureterocystoneostomy (UCN) between 1995-2000.
- Analysis included pre- and postoperative clinical course, surgical techniques (Cohen's, Leadbetter-Politano), and radiographic examinations.
- Postoperative follow-up included clinical assessment, ultrasonography, and voiding cystourethrography (VCUG) where performed.
Main Results:
- Of 81 patients, 77 (95%) had normal VCUG results one year post-surgery; 4 showed reflux, with 3 asymptomatic.
- One patient developed a fistula with reflux requiring reoperation; VCUG was performed earlier due to clinical and ultrasound findings.
- Routine VCUGs did not alter management decisions, as all detected pathologies were identified through clinical or ultrasonographic evaluation.
Conclusions:
- Routine postoperative voiding cystourethrography (VCUG) after ureterocystoneostomy (UCN) provides minimal added value in detecting significant issues.
- Clinical assessment and ultrasonography are effective for monitoring postoperative outcomes.
- VCUG should be reserved for cases with specific clinical or ultrasonographic indications, optimizing resource use and minimizing patient burden.
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