Cystography after the Cohen ureterovesical reimplantation: Is it necessaryat a training center?

Purpose: Reimplantation by the Cohen procedure has a low rate of recurrent reflux, although postoperative cystography is done routinely at most center s. According to the French training program for pediatric surgery and urolo gy residents, reimplantation is the main pediatric urology procedure perfor med during residency. We determine whether it is necessary to perform posto perative cystography routinely and whether the fact that the procedure is d one by a junior surgeon modifies management. Materials and Methods: A total of 268 children with primary vesicoureteral reflux underwent ureteral reimplantation by the Cohen transtrigonal techniq ue. Bilateral reimplantation was done in 97% of the cases. Reimplantation w as performed by a surgery resident assisted by a clinical fellow or senior consultant surgeon in 37% of the cases. Routine cystography and renal ultra sound were done in all patients postoperatively. Followup ranged from 6 mon ths to 5 years (mean 10 months). Results: In 2 children (0.7%) with recurrent reflux surgery was not perform ed by a resident. One of the 2 children had asymptomatic persistent reflux and no further surgery was done. In the other child postoperative cystograp hy was normal at 6 months. One year later she had acute pyelonephritis with recurrent unilateral reflux and underwent repeat reimplantation. Conclusions: Routine cystography is not necessary after bilateral Cohen rei mplantation. Reflux recurrence is low even at a training center where surge ry may be performed by junior surgeons.