50386 Removal (via snare/capture) of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation

Name of the Procedure:

Removal (via snare/capture) of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation.

Summary

This procedure involves removing a ureteral stent using a snare or capture device through the urethra, without the need for cystoscopy. The procedure is guided by radiological imaging to ensure accurate placement and removal of the stent.

Purpose

Medical Condition or Problem:

The procedure is performed to address and treat issues related to obstructive uropathy (e.g., kidney stones, strictures, or other conditions requiring temporary stenting of the ureter).

Goals/Expected Outcomes:

• Safely remove the ureteral stent.
• Relieve symptoms associated with the stent or underlying condition.
• Reduce the risk of complications like stent encrustation, infection, or migration.

Indications

• Persistent pain or discomfort associated with the stent.
• Indications of stent obstruction or malfunction.
• Scheduled stent removal after treatment of the underlying condition.
• Infection attributed to the stent.

Preparation

• Patients may be advised to fast for a few hours before the procedure.
• Full bladder needed - Patient should drink plenty of fluids before the procedure.
• Adjustments in blood-thinning medications may be required.
• Pre-procedure imaging or lab tests to assess the position of the stent and overall kidney function.

Procedure Description

1. The patient is positioned comfortably on a procedural table.
2. The urethral area is cleansed to maintain sterility.
3. A specialized snare or capture device is inserted through the urethra.
4. Radiological imaging is used to guide the device towards the stent.
5. The device captures the stent, and it is carefully removed.
6. Continuous radiological supervision ensures no part of the stent is left behind.
7. Post-removal imaging confirms successful removal and checks for immediate complications.

Tools, Equipment, or Technology:

• Specialized snare/capture device.
• Radiological equipment for supervision (e.g., fluoroscopy).

Anesthesia or Sedation:

• Local anesthetic or mild sedation may be used for patient comfort.

Duration

The procedure typically takes around 30 minutes to 1 hour.

Setting

• Hospital or outpatient clinic with radiological facilities.

Personnel

• Urologist or trained healthcare professional.
• Radiologist for imaging supervision and interpretation.
• Nurses or clinical assistants.

Risks and Complications

Common Risks:

• Mild discomfort or pain during and after the procedure.
• Minor bleeding or spotting.

Rare Risks:

• Infection.
• Urinary tract injury.
• Incomplete removal of the stent.
• Allergic reactions to anesthetic or contrast dye.

Benefits

• Effective removal of the ureteral stent with minimal invasiveness.
• Quick resolution of symptoms related to the stent.
• Immediate visualization confirms successful removal.

Recovery

• Patients are typically observed for a short period post-procedure.
• Normal activities can usually be resumed within a day.
• Increased fluid intake is often recommended.
• Follow-up appointments to monitor for urinary function and complications.

Alternatives

• Cystoscopy-guided stent removal.
• Surgical removal if non-invasive methods are not suitable.

Pros and Cons:

• Compared to cystoscopy, the described procedure may be less invasive and quicker.
• Surgical removal carries more risks and longer recovery times.

Patient Experience

• The patient might feel slight discomfort during the procedure.
• Pain management includes local anesthesia and supplemental pain relief if necessary.
• Post-procedure, some mild pain or burning during urination may be experienced, which usually resolves within a few days.