VOIDING CYSTOURETHROGRAPHY AFTER UNCOMPLICATED URETERAL REIMPLANTATION IN CHILDREN - IS IT NECESSARY

Purpose: Our aim was to assess whether a voiding cystourethrogram afte r uncomplicated ureteral reimplantation is necessary or cost-efficient . Materials and Methods: We retrospectively reviewed the records of pa tients who underwent uncomplicated reimplantation at our institution f rom 1988 to 1994. We also reviewed the literature to tabulate the refl ux resolution rate from all published series of more than 100 ureters reimplanted. Results: At our institution 119 patients (207 ureters) un derwent uncomplicated reimplantation and a postoperative voiding cysto urethrogram, which documented a 98.6% initial reflux resolution rate. All persistent postoperative reflux resolved spontaneously without tre atment for a final resolution rate of 100%. We reviewed 1,494 abstract s using vesicoureteral reflux as a key word and found 19 series of mor e than 100 ureters reimplanted. The combined results of our series and those 19 from the literature revealed 3,346 patients (5,008 ureters r eimplanted). The final reflux resolution rate was 98.58%. Series that included and excluded secondary vesicoureteral reflux documented final reflux resolution rates of 98.4 and 99.04%, respectively. Reflux reso lved spontaneously in 85% of the ureters in which it was noted on the initial postoperative cystogram. At our institution the cost of a void ing cystourethrogram is $610 and we perform an average of approximatel y 20 uncomplicated reimplantations per year. In the United States ther e are approximately 230 pediatric urologists. If each surgeon performe d 20 reimplantations per year at the same cost per voiding cystourethr ogram, a cost savings of $2.8 million per year would result if the stu dy were not performed after surgery. Conclusions: In the hands of expe rienced pediatric urologists uncomplicated ureteral reimplantation has a success rate of 99.04%. The yield of postoperative voiding cystoure thrography is exceedingly low and a cost savings of $2.8 million per y ear would result by omitting the postoperative voiding cystourethrogra m.