Background: Following ureteral reimplantation a renal ultrasound at 4 weeks postoperative is obtained to rule out new or increased hydronephrosis and a VCUG around 3 months postoperative to ensure resolution of reflux. A renal ultrasound is obtained 1 year postoperative to rule out delayed obstruction. Given the high success rate, 98-99%, with open reimplantation postoperative VCUGs are less frequently obtained. Similarly, the risk of obstruction is low, particularly delayed obstruction. We review our experience with open ureteral reimplantation to assess the utility of the 1 year postoperative ultrasound.
Methods: A retrospective review of 109 patients (235 ureters) who underwent uncomplicated Cohen cross trigonal ureteral reimplantation over a 6.5 year period was performed. Renal ultrasounds were obtained at 1 month and 1 year postoperative. A postoperative VCUG was obtained in 72 of the 109 patients.
Results: Of the 109 patients (235 ureters) 4 patients developed obstruction requiring placement of a JJ stent in 5 ureters (2.2%). These patients developed symptoms within one week of the surgery. One patient underwent bilateral JJ stent placement for bilateral hydronephrosis and renal insufficiency, whose creatinine did not improve after stent placement. Further evaluation demonstrated significant bilateral renal scarring. All 4 patients underwent stent removal one month after placement and none required further intervention. No patient underwent treatment for obstruction based on the 1 month postoperative renal ultrasound. Renal ultrasound was obtained in 92 of the 109 patients at one year postoperative. There was no new or worsening hydronephrosis. None of the 72 children who underwent a VCUG at 3 months postoperative had reflux.
Conclusions: Traditionally, it has been recommended that a renal ultrasound be obtained in children 1 year after open ureteral reimplantation to rule out delayed obstruction. Our study suggests that this is of low yield in uncomplicated ureteral reimplantation. Furthermore, this study supports the concept that routine postoperative VCUG is not warranted in uncomplicated ureteral reimplantation.

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