Lopes J F, Cendron M, Ellsworth P I
Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756-0001, USA.
Urology. 2001 Jun;57(6):1156-8; discussion 1158-9. doi: 10.1016/s0090-4295(01)01049-4.
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.
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.
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.
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.
评估在膀胱输尿管反流手术修复前立即进行膀胱镜检查对计划手术及相关费用的影响。膀胱镜检查通常在输尿管膀胱再植术时进行，以排除先前未被怀疑的异常情况，如输尿管囊肿或输尿管重复畸形。
我们回顾性分析了1994年至2000年间因原发性膀胱输尿管反流接受输尿管再植术的128例患者的术前排尿性膀胱尿道造影和超声检查结果。将影像学检查结果与膀胱镜检查及再植术中的观察结果进行比较，以确定在手术医生和/或放射科医生认为放射学评估充分的情况下，未被怀疑的输尿管囊肿或重复畸形的发生率。然后我们进行了详细分析，以确定膀胱镜检查对该手术费用的贡献。
在128例患者中，1例（0.7%）在膀胱镜检查时发现有一个小的、未被诊断出的输尿管囊肿。对该患者术前评估的回顾显示，她的超声检查不完整，缺少膀胱的图像。在我们机构，膀胱镜检查使该手术的直接和间接手术室总费用增加了16.2%，在原费用762.97美元的基础上增加了123.77美元。
在术前放射学评估充分的情况下，输尿管再植术前进行常规膀胱镜检查获得的诊断信息很少。在本系列研究中，它对即将进行的手术没有影响，但确实显著增加了费用。对于原发性反流，仅在那些放射学检查可疑或不充分的儿童中考虑输尿管再植术前的膀胱镜检查。
