Are postoperative studies justified after extravesical ureteral reimplantation?

Purpose: We evaluated the usefulness of postoperative imaging studies after extravesical ureteroneoeystostomy and identified patient subsets in which these studies are necessary. Materials and Methods: Records of 438 patients who had undergone extravesic al ureteroneocystostomy from 1991 to 1997 were reviewed retrospectively. St udy inclusion criterion was primary reflux with at least 1 year of postoper ative followup. Grades I to III reflux were defined as low, and grades TV a nd V were defined as high. All patients were on prophylactic antibiotics. E valuation included ultrasound and a voiding cystourethrogram 3 months posto peratively, and if reflux persisted the studies were repeated at 12 months. Results: A total of 438 patients (723 renal units) underwent extravesical u reteral reimplantation. At 3 months the procedure was successful in 93.2% o f ureters (91.3% patients), and at 12 months the success rate increased to 97.9% of ureters (95.4% patients). There were 49 renal units in 38 cases th at were refluxing at 3 months, 11 of which were contralateral. At 12 months reflux resolved spontaneously in 20 of 38 ipsilateral and 8 of 11 contrala teral ureters. Of the remaining 18 ipsilateral units reflux was high grade preoperatively in 12 and persisted postoperatively in 4. There was a statis tically significant difference in the success rate at 1 year between high ( 94%) versus low (99%) grade reflux (p = 0.007). Age and preoperative bladde r function did not significantly affect the success rates but males had a l ower success rate. Hydronepkrosis was noted in 7.2% of ureters at 6 weeks a nd in only 0.005% at 12 months. Conclusions: Extravesical reimplantation is successful in treating vesicour eteral reflux. Postoperative voiding cystourethrogram should be reserved fo r high grade reflux. Limiting these studies will help reduce patient discom fort and the cost of treatment.