The Utility of Radiologic and Symptomatic Surveillance After Minimally-invasive Adult Pyeloplasty

Area of Science:

• Urology
• Minimally-Invasive Surgery
• Radiology

Background:

• Minimally-invasive pyeloplasty (MIP) is a common procedure for ureteral obstruction.
• Assessing postoperative outcomes and predicting recurrence are crucial for patient management.

Purpose of the Study:

• To evaluate failure types after MIP based on initial postoperative imaging and symptoms.
• To stratify risk of recurrent obstruction and guide surveillance strategies.

Main Methods:

• Retrospective review of 122 adult patients undergoing MIP with at least 11 months follow-up.
• Categorization of initial postoperative imaging as normal, equivocal, or obstructed (obstructed excluded).
• Primary outcome: procedural failure; Secondary outcomes: radiologic and symptomatic failure.

Main Results:

• Procedural failure rates were 6.5% for normal imaging vs. 28.6% for equivocal findings (P=.023).
• Radiologic failure occurred in 6.5% of unobstructed and 14.3% of equivocal groups (P=.275).
• Only 0.9% of asymptomatic patients with normal initial imaging required salvage procedures.

Conclusions:

• Recurrent obstruction after MIP is influenced by initial radiologic findings.
• Asymptomatic patients with normal initial imaging have a very low risk of future failure.
• Findings can inform patient counseling and surveillance schedule decisions.