To Cohen And Forget? Evaluation Of Postoperative Imaging Studies After Transtrigonal Ureteric Reimplantation For Vesicoureteric Reflux In Children

Main Category: Pediatrics / Children's Health
Also Included In: Urology / Nephrology
Article Date: 13 Oct 2008 - 2:00 PST

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UroToday.com - A study out of Zurich, Switzerland evaluated the use of VCUG studies after crossed trigonal ureteral reimplantation. The study retrospectively reviewed 126 consecutive patients who underwent Cohen crossed trigonal ureteral reimplantations. Inclusion criteria were primary vesicoureteral reflux and greater than five years of follow-up. The follow-up imaging consisted of serial ultrasounds and one VCUG, as well as an intravenous pyelogram in each patient.

The study found that of the 126 patients, 2 required reoperation for contralateral reflux and pyelonephritis. In all other patients, the results of the VCUG did not alter management. The group also correlated that any dilation on the intravenous urography was also seen on renal bladder ultrasound. All of these resolved spontaneously, and no new dilation was observed in any of the patients after one year of follow-up.

The group concluded that routine postoperative VCUG and renal functional studies were not warranted in asymptomatic patients after crossed trigonal reimplantation. Only patients with breakthrough pyelonephritis after surgery warranted imaging studies. In the majority of the patients, follow-up with renal bladder ultrasound was sufficient. They recommended an early study be done first within a couple of months of surgery and then once per year after surgery. In their opinion, in these patients, elimination of routine VCUG and functional studies would decrease morbidity and cost after reimplantation.

It appears that reimplantation surgery is withstanding the test of time. This evaluation is also currently being performed for the laparoscopic approach. It appears to be promising. In our experience, VCUG studies, after more than 100 reimplants, do not seem to be warranted unless a child has breakthrough urinary tract infections.

Falkensammer ML, Gobet R, Stauffer UG, Weber DM
Urol Int. 2008;81(2):218-21
doi:10.1159/000144065

Written by UroToday.com Medical Editor Pasquale Casale, MD

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