Are pre-operative urine cultures and cystoscopies before ureteral reimplantation clinically useful or cost effective?

Date

2022

Authors

Hinkley, Dawson
Davis, Erin
Quiring, Mark
Hamby, Tyler
Reyes, Kristy
Pinto, Kirk

ORCID

0000-0002-4127-3756 (Quiring, Mark)

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Abstract

Purpose: Ureteral reimplantation remains the primary treatment for patients with vesicoureteral reflux (VUR) and recurrent urinary tract infections (UTI). Cystoscopies may be performed prior to reimplantation to rule out the presence of anatomic abnormalities, which may alter the procedure. Additionally, urine cultures may be obtained preoperatively for patients with VUR even if asymptomatic for UTI. The goal of this study was to evaluate whether preoperative urine cultures and/or cystoscopies offer a clinical advantage in pediatric patients undergoing ureteral reimplantation. Methods: Pediatric urologists responded to a 7-item survey to report their routine practices regarding urine cultures on asymptomatic patients and cystoscopies prior to reimplantation. Additionally, a retrospective review of patients who underwent ureteral reimplantation for VUR between March 2018 and April 2021 at Cook Children's Medical Center in Fort Worth, TX was performed. Variables included demographics, urine cultures, cystoscopies, whether cystoscopies altered the surgeons' planned procedure, and complications. Results: When physicians were asked how often they performed routine urine cultures before reimplantation on asymptomatic patients, 36% said never and 38% said always. Regarding performing cystoscopies at the time of reimplantation, 53% said never and 32% said always. For the retrospective review, 101 patients (28% male) met inclusion criteria. The median (range) age was 3.98 (0.56-10.93) years at surgery. Cystoscopies were performed in 46 (46%) patients and did not alter the surgical procedure for any patient. There were 20 (20%) preoperative, 90 (89%) intraoperative, and 61 (61%) postoperative urine cultures. Complications were associated with positive urine cultures intraoperatively and postoperatively but not preoperatively. Conclusion: Cystoscopies and asymptomatic urine cultures obtained prior to ureteral reimplantation provide limited to no additional benefit for patients. Obtaining either without reasonable cause may bring about avoidable cost or inconvenience for patients and their families. Further research is needed to thoroughly identify the role that cystoscopies and urine cultures serve for patients undergoing ureteral reimplantation for VUR.

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