UroToday - Radiographic imaging surveillance for stricture formation and obstruction would seem not to be mandatory after uncomplicated ureteroscopy and stone removal.

This study from Turkey included 268 patients with ureteral stones having a mean size of 1.7 cm (range 0.8-3.0 cm). All patients were treated with an 8 or 10 French semi-rigid ureterscope, pneumatic lithotripter and stone baskets. A ureteral stent or ureteral catheter was placed in 60% of the patients and all patients underwent a KUB on post-operative day 1, post-operative day 10 and then an IVU and/or ultrasound at 3 months post-operatively and then annually.

Complete stone clearance was achieved in 95.5% of patients at 3 months follow-up. There were no ureteral avulsions or perforations. Forty (15%) of patients complained of symptoms at 3 months and 2 (5%) of these patients had obstruction from a distal ureteral stricture (1) or residual stone fragments (1). Of the 228 asymptomatic patients, one (0.4%) had silent obstruction at 3 months from a distal ureteral stricture and residual stone fragments.

At a mean follow-up of 27 months no additional complications were identified. None of the patients who were stone free on post operative day 1 developed obstruction at longer follow-up. Therefore, patients who have an uncomplicated ureteroscopy and stone removal procedure and are deemed stone free on post-operative day 1 require no further radiographic imaging. However, any patient with a complex or complicated surgical procedure, residual stone on post-operative day 1 radiographic imaging, or post-operative symptoms should be followed closely with imaging to detect obstruction.

Reported by UroToday Contributing Editor Elspeth M. McDougall, MD

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