00918 Anesthesia for transurethral procedures (including urethrocystoscopy); with fragmentation, manipulation and/or removal of ureteral calculus

Name of the Procedure:

Anesthesia for transurethral procedures (including urethrocystoscopy); with fragmentation, manipulation, and/or removal of ureteral calculus.

Summary

This procedure involves providing anesthesia during the removal or fragmentation of kidney stones (ureteral calculus) using a scope inserted via the urethra. It allows for the stones to be broken down or removed with minimal discomfort.

Purpose

The procedure is designed to address kidney stones that are causing pain, urinary obstruction, or other complications. The main goals are to safely remove or break down the stones while minimizing patient discomfort and promoting a quick recovery.

Indications

• Severe pain due to ureteral calculus (kidney stones).
• Urinary obstruction or difficulty urinating due to stones.
• Recurrent urinary tract infections linked to kidney stones.
• Hematuria (blood in the urine).
• Stones that have not passed naturally.

Preparation

• Patient may need to fast for a specific period before the procedure.
• Adjustments to current medications, particularly blood thinners, may be necessary.
• Pre-procedure diagnostic tests including imaging studies like ultrasound or CT scan to locate the stones.

Procedure Description

1. The patient is positioned on the examination table, typically in a lithotomy position.
2. Sedation or general anesthesia is administered to ensure the patient is comfortable and pain-free.
3. A urethrocystoscope is gently inserted through the urethra into the bladder and ureter.
4. The location of the ureteral stones is confirmed via imaging or direct visualization.
5. Techniques like laser lithotripsy or mechanical devices are used to fragment the stones.
6. Large stone fragments are removed using specialized graspers or a basket tool.
7. A stent may be placed temporarily to ensure proper urine flow and reduce swelling.
8. The instruments are then carefully removed, and the patient is monitored during the recovery from anesthesia.

Duration

The procedure generally takes about 1 to 2 hours, depending on the complexity and number of stones.

Setting

Performed in a hospital or surgical center, typically in an operating room equipped with specialized instruments.

Personnel

Involves urologists, anesthesiologists, nurses, and surgical technicians.

Risks and Complications

• Infections
• Bleeding
• Injury to the urinary tract
• Anesthesia-related risks
• Temporary difficulty urinating
• Rarely, stricture formation or persistent kidney pain.

Benefits

• Immediate relief from pain and obstruction caused by kidney stones.
• Prevention of recurrent urinary tract infections.
• Improved urinary function.
• Fast recovery with minimal discomfort.

Recovery

• Post-procedure monitoring until anesthesia wears off.
• Pain management, possibly including over-the-counter analgesics.
• Increased fluid intake to promote stone fragment passage.
• Temporary urinary catheter or stent care if placed.
• Follow-up imaging or visits to monitor recovery and stone fragments.
• Patients can generally return to normal activities within a few days, with some restrictions on strenuous activities for a week or two.

Alternatives

• Conservative management with increased fluid intake and pain management, waiting for the stone to pass naturally.
• Extracorporeal shock wave lithotripsy (ESWL).
• Percutaneous nephrolithotomy.
• Each alternative has its own benefits and risks, which should be discussed with a healthcare provider.

Patient Experience

During the procedure, the patient should not feel pain due to effective anesthesia. Post-procedure, mild discomfort or a feeling of pressure may occur, which is manageable with medication. Hydration and movement facilitate recovery, and any stent-related discomfort is temporary.