Name of the Procedure:

Renal Endoscopy through Established Nephrostomy or Pyelostomy, with or without Irrigation, Instillation, or Ureteropyelography

Summary

Renal endoscopy through an established nephrostomy or pyelostomy is a minimally invasive procedure where a tiny camera is inserted through an existing opening (nephrostomy or pyelostomy) in the kidney to examine, irrigate, or treat the renal system. This can be performed with or without additional interventions like irrigation, medication installation, or imaging (ureteropyelography).

Purpose

This procedure is used to diagnose and treat various kidney problems, such as stones, tumors, or strictures. The goals are to visualize the internal structures of the renal system, treat identified issues, and possibly obtain diagnostic samples.

Indications

• Persistent kidney stones
• Tumors or abnormal masses
• Strictures or narrowing in the urinary tract
• Unexplained hematuria (blood in the urine)
• Hydronephrosis (swelling of the kidney due to urine build-up)

Preparation

• Fasting for at least 6-8 hours before the procedure
• Adjusting or stopping certain medications (e.g., blood thinners)
• Blood and urine tests to assess health status and kidney function
• Possible imaging tests (e.g., ultrasound, CT scan) to plan the procedure

Procedure Description

1. The patient is given local anesthesia, sedation, or general anesthesia as needed.
2. A thin, flexible endoscope is passed through the existing nephrostomy or pyelostomy opening.
3. The endoscope provides visual access to the inside of the kidney and urinary tract.
4. Irrigation may be used to wash out debris or provide a clearer view.
5. Medication instillation can be done to treat infections or other conditions.
6. Ureteropyelography, an imaging technique, might be performed to obtain detailed images.
7. Any necessary interventions, such as stone removal or biopsies, are conducted.
8. The endoscope is withdrawn, and the nephrostomy or pyelostomy site is secured.

Duration

The procedure typically takes 30 minutes to 1 hour, depending on the complexity.

Setting

This procedure is usually performed in a hospital or specialized outpatient surgical center.

Personnel

• Urologist
• Nursing staff
• Anesthesiologist (if general anesthesia is required)
• Radiology technician (if imaging is conducted)

Risks and Complications

• Infection
• Bleeding
• Injury to the kidney or surrounding structures
• Adverse reactions to anesthesia

Benefits

• Minimally invasive with a shorter recovery time
• Accurate diagnosis of renal issues
• Ability to treat certain conditions during the procedure
• High success rate for stone removal and other interventions

Recovery

• Monitoring for a few hours post-procedure if done under sedation or anesthesia.
• Instructions on wound care at the nephrostomy or pyelostomy site.
• Possible antibiotics to prevent infection.
• Avoiding strenuous activity for a few days.
• Follow-up appointments to assess healing and treatment efficacy.

Alternatives

• Open surgery, which is more invasive with longer recovery times
• Extracorporeal shock wave lithotripsy (ESWL) for stone treatment
• Medical management with medications
• Observation, depending on the patient's condition

Patient Experience

During the procedure, sedation or anesthesia ensures the patient is comfortable and pain-free. Post-procedure, there may be mild discomfort at the nephrostomy or pyelostomy site, manageable with pain medications. Most patients can resume normal activities within a few days, with specific instructions provided by their healthcare team regarding care and follow-up.