Is routine radiological surveillance mandatory after uncomplicated ureteroscopic stone removal?
OBJECTIVE
Stricture formation and obstruction are rare but significant complications after ureteroscopy (URS), and there are controversial studies regarding follow-up. Our study sought to determine the appropriate follow-up for patients without complications.


METHODS
A total of 323 patients were treated with URS for removal of ureteric stones, and their charts were retrospectively reviewed. A semirigid ureteroscope was used in all patients, and stone disintegration was accomplished with a pneumatic lithotriptor. Postoperative evaluation included plain abdominal radiograph of the kidneys, ureters, and bladder (KUB) on day 1, intravenous urography (IVU) and/or ultrasonography at postoperative month 3 and annually thereafter in all patients. A KUB radiograph was also obtained on postoperative day (POD) 10 in patients with residual fragments.


RESULTS
Complete records of 268 patients were available. The overall success rate was 95.5%. The KUB radiograph on POD 1 revealed complete stone removal in 217 (80.9%) patients, while residual fragments were seen in 40 (14.9%) patients, who were reevaluated on POD 10. Evaluation on POD 10 showed residual fragments in 15 patients, and URS was again performed in eight patients. Perioperative minor complications were observed in 18 (6.7%) patients. IVU performed in the third postoperative month showed stricture formation in two (0.7%) patients and silent obstruction in one (0.3%). No stricture formation was observed in asymptomatic patients after uncomplicated complete stone removal. After a mean follow-up of 27.4 +/- 13.7 (range 12-58) months, annual radiologic studies did not show any additional complications.


CONCLUSIONS
Our results indicate that radiologic surveillance for stricture formation and obstruction is not mandatory after complete stone removal with uncomplicated URS.
Karadag
Mert Ali
MA
Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey.
Tefekli
Ahmet
A
Altunrende
Fatih
F
Tepeler
Abdulkadir
A
Baykal
Murat
M
Muslumanoglu
Ahmet Yaser
AY
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011860:Radiography, Abdominal / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000000981:diagnostic imaging* / Q000628:therapy; D018666:Ureteroscopy / Q000379:methods*; D014567:Urography / Q000379:methods*