Follow-up functional radiographic studies are not mandatory for all patients after ureteroscopy

Abstract Objectives. To evaluate the usefulness of follow-up radiographic studies after ureteroscopy by retrospective chart review. Methods. We reviewed the charts of 118 patients who underwent 134 ureteroscopic procedures from January 1998 to November 1999. Results. Follow-up was obtained at our institution for 87 patients. The follow-up period ranged from 3 to 34 weeks (mean 7, SE ± 0.75). Of 10 patients who underwent ureteroscopy for diagnostic purposes, none had postoperative pain or obstruction on follow-up radiographic studies. Of 77 patients who underwent ureteroscopy for calculi, 12 (16%) had postoperative obstruction. One third of patients with residual obstruction (4 of 12) complained of persistent pain versus 6% of patients without evidence of obstruction (4 of 65) ( P = 0.02). Twelve patients had residual stone fragments on their follow-up radiographic studies; 5 (42%) of these patients complained of pain versus 3 (5%) of 65 patients who were stone free after surgery ( P = 0.002). The use of pain to predict either obstruction or residual fragments had a negative and positive predictive value of 83% and 75%, respectively. Preoperative obstruction and postoperative pain were combined as one indicator for the presence of residual fragments and postoperative obstruction. Patients who had preoperative obstruction and presented with postoperative pain had a 67% chance of having residual fragments and a 50% chance of residual obstruction, and 96% of patients without preoperative obstruction and no postoperative pain had no persistent obstruction or residual fragments ( P = 0.001). Conclusions. For patients who present for ureteroscopy with no obstruction and report no pain at follow-up, a plain radiograph may be sufficient. For patients who present with obstruction and report pain during follow-up, functional imaging studies are recommended.