Routine radiologic surveillance for obstruction is not required in asymptomatic patients after ureteroscopy.

OBJECTIVE: A retrospective medical record review was performed with the goal of determining the need for radiologic evaluation after ureteroscopy.

PATIENTS AND METHODS: Of 183 patients undergoing ureteroscopic procedures at our institution between 1989 and 1993, 131 underwent postoperative radiologic studies capable of diagnosing ureteral obstruction. Of these patients, 110 (84%) were asymptomatic after the procedure, and radiologic procedures capable of displaying obstruction were performed at a median of 60 days (mean 73 days; standard deviation 189 days) after ureteroscopy.

RESULTS: None of these asymptomatic patients displayed obstruction at the time of the routine follow-up radiologic procedure. Of those 21 patients (16%) who experienced flank pain subsequent to ureteroscopy, 13 were found to have ureteral obstruction secondary to ureteral calculus. One patient (1/131 or 0.8%) was found to have a ureteral stricture, which occurred after a full-thickness ureteral injury. All cases of postoperative obstruction were heralded by a concomitant display of flank pain.

CONCLUSION: Routine postoperative radiologic studies are not necessary in surveillance for obstruction in the asymptomatic postureteroscopy patient, as obstruction should become evident by virtue of flank pain. The exception to this practice may be in patients experiencing a ureteral perforation intraoperatively, who may be at greater risk of stricture.