Voiding cystourethrography in patients undergoing endoscopic decompression of duplex system ureteroceles: to do or not to do?
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In brief
In brief
This retrospective study of 75 patients evaluates whether preoperative VCUG is necessary before endoscopic decompression of duplex system ureteroceles. Patients with preoperative VUR had significantly higher secondary surgery rates (82%) versus those without VUR (32%) or no VCUG (25%), suggesting VCUG may be reserved for symptomatic cases post-procedure.
- Preoperative VUR significantly increases secondary surgery rate after endoscopic decompression (82% vs 32% without VUR, p=0.0001).
- Routine preoperative VCUG may not be necessary; patients without VCUG had similar outcomes to those without VUR (25% vs 32% SS rate).
- Preemptive endoscopic VUR treatment during decompression reduces secondary surgery rate from 96% to 44% (p=0.003).
- Post-decompression VUR often remains asymptomatic; reserve VCUG for patients developing UTI symptoms during follow-up.
- If preoperative VCUG shows VUR, consider concurrent endoscopic treatment to minimize need for subsequent procedures.
Written by the GCMD Library team from the article.
Abstract
Objective
To assess the role of voiding cystourethrography (VCUG) in patients with duplex system ureterocele (DSU) undergoing endoscopic decompression (ED).
Materials and methods
This is a retrospective study of 75 consecutive patients with DSU undergoing ED [median (range) age, 6 (1–148) months]. Patients were divided into 3 groups, 33 with a VCUG showing vesicoureteral reflux (VUR) before ED (VUR-group), 22 with a VCUG negative for VUR (No-VUR-group), and 20 who did not undergo a VCUG (No-VCUG-group). Secondary surgery (SS) rate was compared among groups.
Results
Groups were comparable for baseline characteristics. SS rate was 82% (27/33) in VUR-group vs. 32% (7/22) in the No-VUR-group (p = 0.0001), and 25% (5/20) in the No-VCUG-group (p = 0.001 vs. VUR-group, and 1 vs. No-VUR-group). In the VUR-group, 9 patients underwent preemptive endoscopic treatment of VUR during ED and SS rate was 44% (4/9) vs. 96% (23/24) in the remainder, p= 0.003. In the No-VCUG-group, a VCUG was performed during follow-up in 9/15 patients and showed reflux in all, although only 2 of these developed a (single) urinary tract infections.
Conclusions
SS rate was significantly higher in patients with preoperative VUR. Instead, it was not significantly different between patients without VUR and those who did not undergo a VCUG before ED, despite all the latter who underwent a VCUG during follow-up had evidence of VUR generally in the absence of symptoms. In our opinion, a VCUG could be limited to patients developing symptoms after ED. If a VCUG is performed before ED, a preemptive treatment of VUR should be taken into consideration.