Objective
To evaluate different types of failure after minimally-invasive pyeloplasty (MIP)
when stratified by initial radiologic study and symptoms after ureteral stent removal.
Methods
We retrospectively reviewed adults who underwent MIP (1996-2019) at a single academic
center. Patients with at least 11 months of follow-up and patients who had a Mag3
scan as their initial postoperative imaging were included. Postprocedure, patients
were categorized as having normal, equivocal, or obstructed imaging based on their
initial radiologic test. Patients who were obstructed were excluded. Primary outcome
was procedural failure, defined as the need for a procedure to treat recurrent obstruction.
Secondary outcomes were radiologic failure and symptomatic failure. Groups were compared
to assess for statistical significance (P <.05).
Results
Overall, 122 patients met inclusion criteria. On initial postoperative imaging, 108
(89%) patients had no obstruction and 14 (11%) had equivocal findings. The procedural
failure rate was 6.5% in the unobstructed group and 28.6% in the equivocal group (P = .023). Seven unobstructed patients (6.5%) and 2 equivocal patients (14.3%) eventually
experienced radiologic failure (P = .275). Among patients who had no obstruction on initial imaging and remained asymptomatic,
only one (0.9%) required a salvage procedure.
Conclusion
Recurrent obstruction after pyeloplasty varied based on the outcome of the initial
radiologic study. These rates can be used to counsel patients and guide physicians’
choice of surveillance schedules. The risk of future failure is very low in asymptomatic
patients with normal initial imaging. The utility of routine radiologic surveillance
in these patients may be limited.
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Article info
Publication history
Published online: January 24, 2023
Accepted:
January 10,
2023
Received:
October 4,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
