Cystoscopy at the time of ureteral reimplantation for primary vesicoureteral reflux: is it necessary? Incidence of undetected anomalies and cost.
OBJECTIVES: To evaluate the impact on the planned procedure and associated cost of cystoscopy performed immediately before the surgical repair of vesicoureteral reflux. Cystoscopy is commonly performed at the time of ureteroneocystostomy to rule out a previously unsuspected anomaly such as ureterocele or ureteral duplication. METHODS: We retrospectively reviewed the results of preoperative voiding cystourethrograms and ultrasound studies performed on 128 patients who underwent ureteral reimplantation for primary vesicoureteral reflux between 1994 and 2000. Radiographic findings were compared with observations made at cystoscopy and reimplantation to determine the rate of unsuspected ureterocele or duplication in the presence of a radiologic evaluation considered adequate by the operating surgeon and/or radiologist. We then performed an itemized analysis to determine the cost cystoscopy contributed to the procedure. RESULTS: Of the 128 patients, 1 (0.7%) was found to have a small, undiagnosed ureterocele at cystoscopy. A review of this patient's preoperative evaluation revealed that her ultrasound examination was incomplete, lacking views of the bladder. At our institution, cystoscopy increased the total direct and indirect operating room costs of this procedure by 16.2%, adding $123.77 to the original cost of $762.97. CONCLUSIONS: Routine cystoscopic examination before ureteral reimplantation in the setting of an adequate preoperative radiologic evaluation yields little diagnostic information. In this series, it did not have an impact on the surgical procedure to be performed but did add significantly to the cost. Cystoscopy before ureteral reimplantation for primary reflux should only be considered in those children with suspicious or inadequate radiologic studies.