ROUTINE STENTOGRAMS ARE NOT NECESSARY BEFORE STENT REMOVAL FOLLOWING RADICAL CYSTECTOMY

Purpose: Although ureteral stents have significantly reduced periopera tive complications of urinary diversion, there is no universal agreeme nt regarding their postoperative management. As part of an effort to e liminate unnecessary studies and hospital costs for radical cystectomy , we recently reviewed our experience with postoperative radiological stent studies to determine their clinical use and cost. Materials and Methods: A retrospective examination of medical records and radiograph ic studies was performed for 96 patients undergoing cystectomy and uri nary reconstruction between 1989 and 1996. All patients were stented a t the time of surgery. Of the patients 51 underwent bilateral retrogra de ''stentograms'' performed under fluoroscopic guidance before stent removal to evaluate for obstruction or urine leak as dictated by the p reference of the primary surgeon in each case. A total of 41 evaluable patients did not undergo stentograms. Results: In this study 102 sten t injections mere performed on 51 patients before stent removal. No pa tients were found to have ureteral obstruction at the ureterointestina l anastomosis, while 1 (0.98%) had a clinically silent anastomotic lea k that healed with conservative measures. Complications directly attri butable to the stent studies, including episodes of urosepsis, were no ted in 9 patients (17.6%). Nine additional leaks were diagnosed in thi s cohort by other means. Half of all leaks were evident clinically and 60% of this group required further invasive procedures. All clinicall y silent leaks healed with conservative measures. Of 41 evaluable pati ents who did not undergo stentograms leak following stent removal deve loped in only 2 and both healed with conservative measures. The additi onal cost of detecting a single anastomotic leak with routine stentogr ams is estimated to be $58,000. Conclusions: Routine evaluation of the ureterointestinal anastomosis with stentograms before stent removal i s unnecessary, costly and may in fact increase patient morbidity.