Confirming routine stentograms after cystectomy is unnecessary

In the current trend of earlier discharge from hospital and minimizing costs with selective intervention instead of routine "standard" orders, most institutions have abolished routine radiographic imaging of the collecting system before stent removal in postcystectomy patients, although clear supportive data from the recent literature is scarce. We retrospectively reviewed our experience with routine postoperative stentograms in 100 cystectomies to confirm that our decision to omit the stentogram procedure does not compromise patient safety and well-being.

We retrospectively reviewed the records of 100 patients who underwent radical cystectomy for bladder cancer. All 100 patients (87 with ileal conduit and 13 with orthotopic neobladder reconstruction) had their ureteroenteric anastomoses stented with feeding tubes that were exteriorized. Retrograde stentogram was performed under fluoroscopic monitoring on postoperative days 7 to 9. The radiology reports were reviewed for any mention of extravasation.

Extravasation was detected on the stentograms of 5 of 197 (2.5%) ureteroenteric anastomoses. Clinical signs suggestive of an anastomotic leak had preceded the imaging studies in 4 of the 5 cases. After expectant management, only 1 patient (1.0%) required intervention with percutaneous nephrostomy.

The relatively low extravasation rate and the infrequent need for active intervention coupled with the fact that an anastomotic leak can usually be diagnosed on clinical grounds confirms that routine use of stentogram after ureteroenteric anastomoses is not justified. Our decision to perform postoperative stentograms selectively is appropriate.