Does vesicoureteral reflux following ureteroscopy matter? Our experience and a systematic review of the literature

Post-ureteroscopy (URS) vesicoureteral reflux (VUR) is a rarely discussed complication of URS. Here, we highlight current knowledge and outline areas for future research. This was a prospective study including patients aged 18 years and older who underwent 8 Fr semi-rigid URS for ureteral stones. Prior to URS and general anesthesia, the absence of VUR was confirmed using dynamic fluoroscopy, and patients with VUR were excluded. Approximately 2–3 months post-URS, the incidence of VUR was assessed using voiding cystourethrogram (VCUG). In April 2023, a systematic literature search of PubMed was conducted to identify and review literature on post-URS VUR. The study included 53 adult patients with a mean age of 43.0 (standard deviation 13.5) years. VCUG identified VUR (grade I) in only one (1.9%) patient at 8 weeks post-URS. This patient, a 67-year-old woman with a left distal ureteral stone, underwent a 7-day course of antibiotics. A follow-up VCUG at 6 months showed resolution of VUR. A total of 210 articles were reviewed, and based on inclusion and exclusion criteria, 12 studies were ultimately selected. Post-URS VUR occurs in up to 20% of patients but appears to decrease with advancements in instrumentation. It is typically transient and low-grade, though some rare cases require intervention for persistent VUR. Further studies are necessary to address gaps in the literature and explore the need for follow-up and intervention in cases of persistent VUR.