50947 Laparoscopy, surgical; ureteroneocystostomy with cystoscopy and ureteral stent placement

Name of the Procedure:

Laparoscopy, surgical; ureteroneocystostomy with cystoscopy and ureteral stent placement

Summary

Laparoscopy, surgical; ureteroneocystostomy with cystoscopy and ureteral stent placement is a minimally invasive surgical procedure that involves reattaching the ureter to the bladder. This procedure is usually aided by a cystoscopy (a camera inserted into the bladder) and involves placing a stent (a small tube) in the ureter to keep it open.

Purpose

This procedure is performed to address issues where the ureter (the tube that carries urine from the kidney to the bladder) is not properly connected to the bladder, leading to urine flow problems or risk of kidney damage. Goals include restoring normal urine flow, preventing infections, and protecting kidney function.

Indications

• Severe vesicoureteral reflux (backflow of urine from the bladder into the ureter)
• Ureteral obstruction or strictures
• Injuries to the ureter
• Recurrent urinary tract infections caused by ureteral problems

Preparation

• Patients may need to fast for 8-12 hours before the procedure.
• Medication adjustments might be necessary, particularly blood thinners.
• Preoperative blood tests, imaging studies (like ultrasounds or CT scans), and sometimes urinalysis.

Procedure Description

1. Anesthesia: The patient receives general anesthesia.
2. Laparoscopy: Small incisions are made in the abdomen to insert a laparoscope (a thin tube with a camera).
3. Cystoscopy: Another camera is inserted into the bladder through the urethra to visualize the bladder and ureter.
4. Ureteroneocystostomy: The surgeon disconnects the ureter from the bladder and reattaches it to a new position on the bladder.
5. Stent Placement: A stent is placed in the ureter to ensure it remains open during healing.
6. Closure: Incisions are closed with sutures or staples.

Duration

The procedure typically takes between 2 to 4 hours.

Setting

It is usually performed in a hospital's operating room.

Personnel

• Surgeon (typically a urologist)
• Anesthesiologist
• Surgical nurses and technicians

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding organs
• Urinary leakage
• Stent-related discomfort or complications
• Blood clots

Benefits

• Restored normal urine flow
• Reduced risk of kidney damage
• Decreased incidence of urinary tract infections
• Generally, patients start noticing benefits within a few days to weeks post-surgery.

Recovery

• Hospital stay for 1-2 days is common.
• Pain management with prescribed medications.
• Avoid strenuous activities for a few weeks.
• Follow-up appointments to monitor healing and stent removal, usually within 4-6 weeks.

Alternatives

• Endoscopic ureteral reimplantation (less invasive, but not suitable for all cases)
• Open ureteroneocystostomy (more invasive with a longer recovery time)
• Long-term antibiotic prophylaxis and watchful waiting (if the condition is less severe)

Patient Experience

• Initial post-surgery discomfort, manageable with medication.
• Urinary catheter may be present for a day or two.
• Mild to moderate pain around incision sites.
• Stent discomfort may be felt, especially during urination, until it is removed.
• Regular follow-ups for stent removal and to ensure proper healing.

Pain management and comfort measures include prescribed pain relievers and guidance on managing discomfort from the stent.