Presentation Authors: Sapan Ambani*, Peyton Skupin, Bahaa Malaeb, Paholo Barboglio-Romo, John Stoffel, Ann Arbor, MI
Introduction: Ureteroneocystostomy (UN) for stricture disease is routinely followed by surveillance imaging after stent removal to detect recurrent obstruction. There is a lack of standardization for post-operative imaging, and the utility of imaging has yet to be proven. We aimed to determine whether postoperative imaging assisted in the detection of recurrent obstruction after UN.
Methods: Adult patients were identified who underwent a UN with or without psoas hitch or Boari flap between January 2012 and April 2018. Patients who underwent a bilateral procedure, had active malignancy, or were lost to follow up after stent removal were excluded. Using the initial imaging study after stent removal, patients were categorized into normal, equivocal, and obstruction groups according to pre-defined radiologic criteria (Figure). Patients with normal or equivocal initial imaging were followed longitudinally to determine whether they subsequently developed radiographic evidence of obstruction. Follow-up protocol varied by surgeon and was defined by the plan outlined at the time of stent removal. Follow up visits were reviewed for patient complaints of possible post-operative obstruction, defined as flank/abdominal pain, hematuria, UTI.
Results: Ninety-seven patients met inclusion criteria. Primary UN was performed in 38 patients, psoas hitch in 17 patients, and Boari flap in 42 patients. Five patients demonstrated obstruction on initial imaging after stent removal, all of whom necessitated imaging earlier than planned due to symptoms. Normal and equivocal initial imaging was seen in 82 and 10 patients respectively (Figure). Univariate analysis between groups demonstrated no difference in demographics, intra-operative outcomes, post-operative complications, readmission, or failure. At a mean radiologic follow up of 17.2 months, 1 patient developed recurrent obstruction, which was later found to be due to malignancy rather than stricture recurrence.
Conclusions: Asymptomatic patients after UN who had either normal or equivocal post-operative imaging did not benefit from additional radiologic testing in this cohort. All patients that demonstrated failure presented with symptomatic obstruction that warranted imaging. Surgeons may consider imaging only symptomatic patients after the initial post-operative period.