Is There a Benefit from Routine Voiding Cystourethrography after Ureterocystoneostomy?

Abstract

Surgical repair such as ureterocystoneostomy (UCN) for vesicoureteral reflux (VUR) or primary obstructive megaureter (POM) is the treatment of choice after the failure of conservative therapy. To document the postoperative outcome, a voiding cystourethrography is routinely performed to exclude persisting reflux. Our aim was to evaluate the benefit of voiding cystoureterography (VCUG) in our patients with respect to radiation, discomfort to the child and costs. The medical records of all patients who underwent an ureterocystoneostomy at the Department of Paediatric Surgery in St. Gallen, Switzerland, between January 1, 1995 and December 31, 2000 were reviewed in terms of the pre- and postoperative clinical course, type of surgical procedure and radiographic examinations performed. During this period, 126 renal units were operated in 81 patients. The surgical technique employed was Cohen's procedure in 121 (96 %) renal units and a Leadbetter-Politano procedure in 5 (4 %) renal units. Mean postoperative follow-up was 42 months (6 - 84). All patients had an ultrasonographic follow-up. 77 (95 %) patients underwent a VCUG with normal results one year postoperatively. VUR was found in 4 patients, 3 of them were asymptomatic one year postoperatively, one had a complication of a fistula with reflux and required reoperation 2 months after operation. The VCUG was performed earlier because of clinical und ultrasonographic findings. None of the routinely performed VCUGs led to a change of procedure. All pathologies had already been detected by clinical or ultrasonographic findings. We recommend clinical and ultrasonographic follow-up after an UCN and performance of a VCUG only when problems appear to be present.