Cystourethroscopy; with treatment of ureteral stricture (eg, balloon dilation, laser, electrocautery, and incision)
CPT4 code
Name of the Procedure:
Cystourethroscopy with Treatment of Ureteral Stricture Common name(s): Cystoscopy with ureteral dilation or incision; Endoscopic treatment of ureteral stricture.
Summary
Cystourethroscopy with treatment of ureteral stricture is a minimally invasive procedure where a specialized camera (cystoscope) is inserted through the urethra to visualize the bladder and ureters. The procedure aims to treat a narrowing (stricture) in the ureter using techniques such as balloon dilation, laser, electrocautery, or surgical incision.
Purpose
This procedure addresses ureteral strictures, which are narrowings that can obstruct urine flow from the kidneys to the bladder. The goals are to relieve the obstruction, restore normal urine flow, and alleviate symptoms such as pain, recurrent urinary tract infections, or hydronephrosis (swelling of the kidney).
Indications
- Symptoms of urinary obstruction such as difficulty urinating, decreased urine flow, or flank pain.
- Recurrent urinary tract infections.
- Hydronephrosis detected by imaging studies.
- Prior unsuccessful non-surgical treatments for ureteral stricture.
- Confirmed diagnosis of ureteral stricture via imaging or endoscopic evaluation.
Preparation
- Fasting for a specified period before the procedure (usually 6-8 hours).
- Adjustment or temporary discontinuation of certain medications (e.g., blood thinners) as advised by the healthcare provider.
- Pre-procedure diagnostic tests such as urine tests, blood work, and imaging studies (e.g., CT scan or ultrasound) to assess the urinary system.
Procedure Description
- Anesthesia: The patient is typically given general anesthesia or spinal/epidural anesthesia to ensure comfort.
- Introduction of cystoscope: A cystoscope is carefully inserted through the urethra into the bladder.
- Visualization: The bladder and ureteral openings are visualized using the cystoscope.
- Treatment:
- Balloon Dilation: A balloon catheter is introduced and inflated at the site of the stricture to widen the narrow segment.
- Laser or Electrocautery: Targeted energy is used to cut through or ablate the stricture.
- Incision: A small cut is made at the stricture to enlarge the passageway.
- Completion: The cystoscope is removed, and the patient is monitored as they recover from anesthesia.
Duration
The procedure usually takes about 30 minutes to 1 hour, depending on the complexity and specific treatment used.
Setting
The procedure is typically performed in a hospital operating room or an outpatient surgical center.
Personnel
- Urologist or surgeon specialized in endoscopic procedures.
- Anesthesiologist.
- Surgical nursing team.
Risks and Complications
- Infection.
- Bleeding.
- Injury to the urethra, bladder, or ureter.
- Recurrence of stricture.
- Rarely, complications from anesthesia.
Benefits
- Relief from symptoms of ureteral obstruction.
- Improved urine flow.
- Reduced risk of recurrent urinary infections and kidney damage.
- Most patients experience improvement soon after the procedure.
Recovery
- Post-procedure monitoring for a few hours to ensure stability.
- Instructions on fluid intake, activity restrictions, and pain management.
- Temporary discomfort or urinary symptoms such as mild burning or urgency might occur.
- Follow-up appointment with the urologist to assess outcomes and remove any stents, if placed.
Alternatives
- Observation and medical management for mild cases.
- Ureteral stent placement without dilation or incision.
- Open surgical repair of the ureteral stricture.
- Endopyelotomy or percutaneous nephrostomy in severe cases. Each alternative has its own pros and cons, including different risk profiles and effectiveness rates.
Patient Experience
- During the procedure: The patient will be under anesthesia and should not feel pain.
- After the procedure: Mild discomfort or burning during urination, which can be managed with pain relievers.
- Support measures: Adequate hydration, pain management, and instructions for recognizing signs of complications.
Note: This markdown text is intended for informational purposes and should not replace medical advice. Always consult with a healthcare professional for personalized medical guidance.