MP71-17 POINT OF CARE ULTRASOUND IS AN ACCURATE, TIME-SAVING, AND COST-EFFECTIVE MODALITY FOR POSTOPERATIVE IMAGING AFTER PYELOPLASTY

Abstract

INTRODUCTION AND OBJECTIVE: Dismembered pyeloplasty is considered the gold standard treatment for ureteropelvic junction obstruction (UPJO). Although the frequency and timing of follow up imaging after pyeloplasty is variable, ultrasound (US) is commonly utilized. With minimal training, point of care ultrasound (POCUS) can be easily performed by a urologist during a postoperative visit. Our hypothesis is that POCUS is an accurate, time-saving, and cost-effective alternative to a complete retroperitoneal ultrasound (CRUS) performed by a radiologist after pyeloplasty. METHODS: The clinical records of all children who underwent pyeloplasty (by any method) over a 12 month period at our institution were retrospectively reviewed. The exact timing and method (POCUS vs. CRUS) of follow up imaging was surgeon-dependent. Statistical analysis was performed to compare the time and cost of POCUS vs. CRUS. The clinical course of each patient who had each type of imaging was assessed. RESULTS: A total of 45 patients were included in this analysis. 33 were performed laparoscopically with robotic assistance and 12 were performed with open surgery. Over a mean follow up period of 29 months, a total of 71 CRUS and 70 POCUS were performed. Despite an average increased cost of $618 (total $43,878) and an increased wait time 119 minutes (total 8449 min) of CRUS over POCUS, there was no difference in the rate of the detection of worsening hydronephrosis (HN) between either modality (p > 0.05). The recommended follow up time for observed HN was no different between CRUS and POCUS (p > 0.05). Children with worsening HN on POCUS underwent functional studies without confirmatory CRUS. Interestingly, two patients had metachronous contralateral UPJOs discovered during postoperative imaging with POCUS. 20 (43%) patients who had attended at least one postoperative visit were eventually lost to follow up. This occurred exclusively in those who did not have worsening ultrasound (p <0.01). There was no difference in the loss to follow up after a follow up POCUS (8) or CRUS (12) (p > 0.05). There were 2 (4%) failed procedures which required eventual reoperative pyeloplasty. 1 of these postoperative failures was detected by POCUS. In this patient, MAG3 showed no deterioration in function (40/60 preoperative to 42/58 prior to salvage pyeloplasty). CONCLUSIONS: POCUS performed by a urologist is an accurate assessment of HN after pyeloplasty with time and cost savings compared to a CRUS performed by a radiologist. POCUS is not associated with any difference in rate of detection of worsening HN or rate of loss to follow up. Source of Funding: None