Cystourethroscopy; with treatment of intra-renal stricture (eg, balloon dilation, laser, electrocautery, and incision)
CPT4 code
Name of the Procedure:
Cystourethroscopy with Treatment of Intra-Renal Stricture
Summary
Cystourethroscopy with treatment of intra-renal stricture is a minimally invasive procedure where a thin, flexible tube with a camera (cystoscope) is used to examine the bladder and urethra. If a narrowing (stricture) is found in the ureter or renal pelvis, it is treated using methods such as balloon dilation, laser, electrocautery, or incision to widen the passage and restore normal urine flow.
Purpose
This procedure is designed to diagnose and treat intra-renal strictures that cause blockages in the urinary tract. The primary goal is to alleviate symptoms like pain, recurrent infections, and impaired kidney function, thereby improving the patient's quality of life and preventing further kidney damage.
Indications
Patients may require this procedure if they exhibit:
- Persistent flank or abdominal pain.
- Recurrent urinary tract infections.
- Obstructed urine flow.
- Blood in the urine (hematuria).
- Reduced kidney function or hydronephrosis detected on imaging.
Preparation
- Patients may be instructed to fast for several hours before the procedure.
- Medication adjustments might be necessary, especially blood thinners.
- Pre-procedure imaging tests like ultrasounds or CT scans may be conducted to locate the stricture.
Procedure Description
- The patient is positioned on the examination table.
- Anesthesia is administered, typically general or regional, to ensure comfort.
- The cystoscope is gently inserted through the urethra and advanced to the bladder and ureter.
- The stricture is located and assessed.
- Depending on the findings, the stricture is treated with one of the following:
- Balloon dilation: A balloon is inflated at the site of the stricture to widen the passage.
- Laser treatment: Laser energy is used to precisely ablate the narrowed area.
- Electrocautery: Heat generated by electrical current is used to cut or remove tissue.
- Incision: Small cuts are made to enlarge the stricture.
- The area is examined post-treatment to ensure the passage is clear.
- The instruments are carefully removed.
Duration
The procedure typically takes about 1 to 2 hours, depending on the complexity.
Setting
It is generally performed in a hospital's surgical suite or an outpatient surgical center.
Personnel
- Urologist or specialized surgeon.
- Anesthesiologist.
- Surgical nurses and support staff.
Risks and Complications
- Infection.
- Bleeding.
- Injury to the ureter or kidney.
- Scar tissue formation that could cause another stricture.
- Adverse reactions to anesthesia.
Benefits
- Improved urine flow and relief of symptoms.
- Prevention of kidney damage.
- Typically minimally invasive with a shorter recovery time compared to open surgery.
Recovery
- Patients might experience slight discomfort or a burning sensation during urination.
- Pain management includes prescribed medications.
- Hydration is encouraged to flush the urinary system.
- Urine may contain some blood for a few days post-procedure.
- Follow-up appointments are necessary to monitor recovery and ensure the strictures do not recur.
Alternatives
- Observation and symptomatic treatment for mild cases.
- Percutaneous nephrostomy to drain the kidney directly.
- Open surgery for severe strictures or if the minimally invasive approach is not feasible.
- The alternatives might have longer recovery times and higher risk profiles.
Patient Experience
During the procedure, the patient will be under anesthesia and should not feel discomfort. Post-procedure, some pain or burning during urination is common, but manageable with medication. Patients are usually able to return to regular activities within a few days to a week, with close follow-up to ensure proper healing and function.