Follow-up functional radiographic studies are not mandatory for all patients after ureteroscopy.
OBJECTIVE
To evaluate the usefulness of follow-up radiographic studies after ureteroscopy by retrospective chart review.


METHODS
We reviewed the charts of 118 patients who underwent 134 ureteroscopic procedures from January 1998 to November 1999.


RESULTS
Follow-up was obtained at our institution for 87 patients. The follow-up period ranged from 3 to 34 weeks (mean 7, SE +/- 0.75). Of 10 patients who underwent ureteroscopy for diagnostic purposes, none had postoperative pain or obstruction on follow-up radiographic studies. Of 77 patients who underwent ureteroscopy for calculi, 12 (16%) had postoperative obstruction. One third of patients with residual obstruction (4 of 12) complained of persistent pain versus 6% of patients without evidence of obstruction (4 of 65) (P = 0.02). Twelve patients had residual stone fragments on their follow-up radiographic studies; 5 (42%) of these patients complained of pain versus 3 (5%) of 65 patients who were stone free after surgery (P = 0.002). The use of pain to predict either obstruction or residual fragments had a negative and positive predictive value of 83% and 75%, respectively. Preoperative obstruction and postoperative pain were combined as one indicator for the presence of residual fragments and postoperative obstruction. Patients who had preoperative obstruction and presented with postoperative pain had a 67% chance of having residual fragments and a 50% chance of residual obstruction, and 96% of patients without preoperative obstruction and no postoperative pain had no persistent obstruction or residual fragments (P = 0.001).


CONCLUSIONS
For patients who present for ureteroscopy with no obstruction and report no pain at follow-up, a plain radiograph may be sufficient. For patients who present with obstruction and report pain during follow-up, functional imaging studies are recommended.
Bugg
Charles E
CE
Division of Urology, University of Alabama at Birmingham, Birmingham, Alabama 35294-3296, USA.
El-Galley
Rizk
R
Kenney
Phillip J
PJ
Burns
John R
JR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D007669:Kidney Calculi / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D008875:Middle Aged; D010149:Postoperative Pain / Q000000981:diagnostic imaging / Q000209:etiology; D017410:Practice Guidelines as Topic; D011859:Radiography; D012189:Retrospective Studies; D014514:Ureteral Calculi / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D014517:Ureteral Obstruction / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D018666:Ureteroscopy