Postoperative Upper Tract Reconstruction Renal Ultrasound Protocol: Safe and Effective Ureteral Stricture...

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

This was a retrospective analysis of a prospectively designed imaging protocol at a single institution, 2016 to 2022. The protocol uses screening RUS at 3 and 12 months, with NMRS or ureteroscopy as clinically indicated. Diagnostic accuracy of 3-month RUS was assessed with 95% CIs.

One hundred thirty-six patients underwent ureteral reconstruction, accounting for 144 reconstructive procedures. The 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 ureteroscopy. Three-month RUS was highly specific (98.1%) for subsequent reintervention, and 102 of 107 renal units (95.3%) with stable/improved hydronephrosis required no intervention. Five of the 6 reinterventions among imaged units followed reassuring ultrasound and were identified by symptom-directed evaluation.

RUS with clinical monitoring is an effective modality for postoperative surveillance after 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.