50384 Removal (via snare/capture) of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation

Name of the Procedure:

Removal (via snare/capture) of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation.

Summary

This procedure involves removing a ureteral stent, a small tube inserted into the ureter, using a snare or capture device through the skin. The removal is guided by imaging techniques to ensure accuracy and safety.

Purpose

The procedure is performed to remove a ureteral stent that may be causing discomfort, infection, or no longer needed post-ureteral healing. The goal is to safely and effectively remove the stent without causing damage to the urinary tract.

Indications

• Persistent pain or discomfort caused by the stent
• Infection or blockage related to the stent
• The stent has served its purpose and is no longer required
• Routine stent replacement to prevent encrustation and obstruction

Preparation

• Fasting for several hours before the procedure to reduce the risk of complications
• Adjustment or temporary discontinuation of certain medications, especially blood thinners
• Pre-procedural imaging studies, such as CT scans or ultrasounds, to guide the removal process

Procedure Description

1. The patient is positioned, and the skin over the insertion site is sterilized.
2. Local anesthesia is administered to numb the area.
3. A small incision is made to access the ureter percutaneously.
4. A snare or capture device is introduced through the incision and guided to the stent using real-time imaging techniques (e.g., fluoroscopy).
5. The device captures the stent, and it is gently removed from the ureter.
6. The site is closed and dressed after successful removal.

Duration

The procedure typically takes about 30 minutes to 1 hour, depending on individual circumstances.

Setting

The procedure is usually performed in a hospital's interventional radiology suite or an outpatient surgical center.

Personnel

• Interventional radiologist or urologist
• Radiology technician
• Nursing staff
• Anesthesiologist or nurse anesthetist (if sedation is required)

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Damage to the ureter or surrounding structures
• Stent fragments remain in the urinary tract
• Allergic reaction to the anesthetic or contrast material

Benefits

• Relief from discomfort or pain caused by the stent
• Lowered risk of infection or obstruction
• Improved urinary function and patient comfort Benefits are often realized immediately after the procedure.

Recovery

• Post-procedure monitoring to ensure there are no immediate complications
• Mild soreness at the incision site, managed with over-the-counter pain medication
• Instructions to avoid strenuous activities for a few days
• Follow-up appointments to monitor healing and ensure complete recovery

Alternatives

• Endoscopic stent removal
  • Pros: No external incision needed
  • Cons: May require general anesthesia
• Watchful waiting
  • Pros: Non-invasive
  • Cons: Risk of complications from prolonged stent placement
• Stent replacement
  • Pros: Maintains ureteral patency
  • Cons: Involves a new stent placement

Patient Experience

During the procedure, the patient might feel pressure or slight discomfort when the local anesthesia is applied, but should not feel pain during the stent capture and removal. Post-procedure, mild soreness at the incision site is common, but effectively managed with pain medication. Most patients experience significant relief from symptoms once the stent is removed and typically resume normal activities within a few days.