Postoperative Cystogram Can Be Safely Omitted After Bladder Cuff Excision in Patients Undergoing Nephroureterectomy

Abstract

In nephroureterectomy (NU), a crucial surgical step is excision of the bladder cuff. A urinary catheter is placed postoperatively and a cystogram prior to catheter removal is often performed to rule out a urine leak from the urinary bladder. We investigated the necessity of cystogram after bladder cuff excision prior to removal of the urinary catheter. A systematic review (SR) was also performed to investigate the incidence of urinary leak on cystography after NU bladder cuff excision. The primary outcomes were postoperative clinical complications including sepsis, fistula, voiding issues after catheter removal and/or any radiological abnormality indicating persistent leak from the bladder. A retrospective study was performed in a centre where cystograms are not routinely performed prior to catheter removal in NU patients. Patients were followed up clinically, radiologically and cystoscopically. A SR of 402 patients demonstrated that the incidence of urine leak from the bladder is 0.003% among patients after catheter removal after NU. In total, 67 patients were included and no clinical, radiological or cystographic evidence of a persistent urinary leak was noted at follow-up due to omission of cystogram. Based on this systematic review, it may be possible to safely omit routine cystography prior to removal of urinary catheter after bladder cuff excision in patients undergoing NU.