Cystoscopy at the time of ureteral reimplantation for primary vesicoureteral reflux: Is it necessary? Incidence of undetected anomalies and cost

Objectives. To evaluate the impart on the planned procedure and associated cost of cystoscopy performed immediately before the surgical repair of vesi coureteral reflux. Cystoscopy is commonly performed at the time of ureteron eocystostomy to rule out a previously unsuspected anomaly such as ureteroce le or ureteral duplication. Methods, We retrospectively reviewed the results of preoperative voiding cy stourethrograms and ultrasound studies performed on 128 patients who underw ent ureteral reimplantation for primary vesicoureteral reflux between 1994 and 2000. Radiographic findings were compared with observations made at cys toscopy and reimplantation to determine the rate of unsuspected ureterocele or duplication in the presence of a radiologic evaluation considered adequ ate by the operating surgeon and/or radiologist. We then performed an itemi zed analysis to determine the cost cystoscopy contributed to the procedure. Results. Of the 128 patients, 1 (0.7%) was found to have a small, undiagnos ed ureterocele at cystoscopy, A review of this patient's preoperative evalu ation revealed that her ultrasound examination was incomplete, lacking view s of the bladder. At our institution, cystoscopy increased the total direct and indirect operating room costs of this procedure by 16.2%, adding $123. 77 to the original cost of $762,97, Conclusions. Routine cystoscopic examination before ureteral reimplantation in the setting of an adequate preoperative radiologic evaluation yields li ttle diagnostic information. In this series, it did not have an impact on t he surgical procedure to be performed but did add significantly to the cost . Cystoscopy before ureteral reimplantation for primary reflux should only be considered in those children with suspicious or inadequate radiologic st udies. UROLOGY 57: 1156-1159, 2001. (C) 2001, Elsevier Science Inc.