Post-Operative Upper Tract Reconstruction Renal Ultrasound Protocol: Safe and Effective Ureteral Stricture...

There is no standardized post-operative surveillance for upper tract reconstruction, with frequent use of nuclear medicine renal scans (NMRS). We propose a protocol utilizing renal ultrasonography (RUS) as the initial assessment tool, reserving secondary studies to evaluate patients with worse hydronephrosis or persistent symptoms.

Retrospective analysis of a prospectively designed imaging protocol at a single-institution, 2016-2022. The protocol uses screening RUS at 3 and 12 months, with NMRS or ureteroscopy (URS) as clinically indicated. Diagnostic accuracy of 3-month RUS was assessed with 95% confidence intervals.

136 patients underwent ureteral reconstruction, accounting for 144 reconstructive procedures. Primary success rate was 91.9%, increasing to 94.1% after revision surgery. Among 110 renal units with paired baseline and 3-month RUS, hydronephrosis was improved in 65.5%, stable in 31.8%, and worse in 2.7%. Eleven patients required reintervention. Based on clinical suspicion and/or worsening imaging, 27 patients (19.9%) underwent NMRS and 18 underwent URS. Three-month RUS was highly specific (98.1%) for subsequent reintervention, and 102/107 renal units (95.3%) with stable/improved hydronephrosis required no intervention. Five of the six reinterventions among imaged units followed reassuring ultrasound and were identified by symptom-directed evaluation.

RUS with clinical monitoring is an effective modality for post-operative surveillance following ureteral reconstruction, allowing more than 80% of patients to avoid NMRS. Stable or improved hydronephrosis reliably identified patients requiring no further intervention, while most failures were detected through symptoms rather than imaging alone. Nuclear scans and ureteroscopy should be reserved for patients with symptoms or imaging suggestive of obstruction.