52353 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included)

Name of the Procedure:

Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy
Common name(s): Cysto, Ureteroscopy with lithotripsy, Pyeloscopy with lithotripsy

Summary

This procedure involves using a scope to look inside the bladder, urethra, and ureters and may extend to the kidneys. It's combined with lithotripsy, a technique to break up stones in the urinary tract.

Purpose

This procedure addresses problems like kidney stones, bladder stones, or ureteral stones that obstruct the urinary tract. The main goal is to visualize and remove or fragment these stones to relieve symptoms and prevent complications.

Indications

• Presence of kidney, bladder, or ureteral stones
• Symptoms such as severe pain, urinary tract infections, hematuria (blood in urine), or obstruction of urine flow
• Patients who have not responded to other treatments

Preparation

• Fasting typically required for at least 6-8 hours before the procedure
• Adjustments in medications as advised by the healthcare provider, especially blood thinners
• Pre-procedure diagnostic tests such as urinalysis, blood tests, and imaging studies like ultrasounds or CT scans

Procedure Description

1. Anesthesia: The patient is usually given general anesthesia or spinal anesthesia.
2. Insertion of Scope: A cystoscope is inserted through the urethra into the bladder.
3. Evaluation: The doctor examines the bladder and urethra, then proceeds with a ureteroscope into the ureter.
4. Stone Fragmentation: Lithotripsy, often using laser energy, is performed to break up the stones.
5. Removal: Fragments of the stones are removed using special baskets or left to pass naturally.

Tools: Cystoscope, ureteroscope, laser lithotripsy equipment
Anesthesia: General or spinal anesthesia

Duration

The procedure typically takes 1 to 3 hours, depending on the complexity.

Setting

Performed in a hospital or surgical center, usually as a same-day outpatient procedure.

Personnel

• Urologist (surgeon)
• Anesthesiologist
• Nursing staff
• Surgical technician

Risks and Complications

• Common: Mild bleeding, infection, urinary discomfort
• Rare: Severe infection, injury to the urinary tract, incomplete stone removal

Benefits

• Effective removal or fragmentation of stones
• Relief from pain and urinary obstruction
• Reduced risk of recurrent urinary infections and kidney damage Benefits are typically realized within a few days to a few weeks post-procedure.

Recovery

• Post-procedure monitoring for several hours
• Pain management with medications
• Drinking plenty of fluids to help flush out stone fragments
• Avoiding strenuous activity for 1-2 weeks
• Follow-up appointments to monitor recovery and ensure no residual stones

Alternatives

• Medical management with drugs to dissolve stones (for specific types of stones)
• Extracorporeal Shock Wave Lithotripsy (ESWL) - less invasive but not always effective for all stones
• Open or laparoscopic surgery - more invasive but may be required for large or complex stones

Patient Experience

• During the procedure: Under general or spinal anesthesia, the patient would be unaware.
• After the procedure: Mild discomfort, possible burning sensation during urination, blood-tinged urine for a few days. Pain management includes prescribed pain relievers, and adequate hydration will help the healing process.