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Asymptomatic Hydronephrosis Following Ureteroscopic vs. Percutaneous Nephrolithotomy
Lawrence M. Dagrosa, MD, Rachel A. Moses, MD, Vernon M. Pais, Jr., MD.
Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
Background: Routine renal ultrasonography following post-ureteroscopy stent remoal has been recommended to screen for post-operative asymptomatic “silent” hydronephrosis. We assessed the incidence of silent hydronephrosis after stent removal in a single endourologic practice.
Methods: 163 patients were identified as having ureteral stent removal by a single surgeon from 2008 to 2011 after undergoing ureteroscopic or percutaneous nephrolithotomy. All patients were scheduled for routine follow-up ultrasound at 4-6 weeks following stent removal. Patients who presented for follow-up imaging were identified and the degree of hydronephrosis reported on imaging recorded (none, mild, moderate or severe.)
Results: Of the 163 patients identified 14 (8.6%) were found to have hydronephrosis on routine ultrasound. In the ureteroscopic group 8 of 121 (6.6%) and in the PCNL group 6 of 42 patients (14%) had evidence of hydronephrosis at routine follow-up (Z = 1.53, p = 0.13).
Conclusions: Our data showing a 6.6% rate of hydronephrosis following ureteroscopy is consistent with previously reported data (0% - 16% in 10 published series since 1999). We now add to the literature an assessment of the rate of silent hydronephrosis following PCNL, which is similar to that rate observed after ureteroscopy.
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