Name of the Procedure:

Renal Endoscopy through Established Nephrostomy or Pyelostomy, with or without Irrigation, Instillation, or Ureteropyelography; with Ureteral Catheterization, with or without Dilation of Ureter

• Common Name: Renal Endoscopy
• Technical Terms: Nephrostomy, Pyelostomy, Ureteropyelography

Summary

Renal endoscopy through an established nephrostomy or pyelostomy is a procedure used to examine the inside of the kidney and ureter. A nephrostomy or pyelostomy tube provides access to the urinary system, allowing for visualization, possible removal of blockages, and installation of diagnostic or therapeutic agents.

Purpose

This procedure addresses obstructions, infections, or other issues within the kidney or ureter. The goals include diagnosing or treating urinary tract conditions, alleviating blockages, and ensuring the proper flow of urine.

Indications

• Persistent or recurrent urinary tract infections
• Kidney stones causing obstruction
• Abnormalities seen in previous imaging studies
• Hematuria (blood in urine) with unclear origin
• Suspected tumors or lesions in the urinary tract

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Blood tests and imaging studies (like ultrasound or CT scan) may be required beforehand.
• Medications may need adjustment, especially blood thinners.

Procedure Description

1. Anesthesia: General or local anesthesia is administered depending on the complexity of the procedure.
2. Access: The surgeon accesses the renal system through an existing nephrostomy or pyelostomy tube.
3. Endoscopy: A thin, flexible tube with a camera (endoscope) is inserted through the access point to visualize the inner lining of the kidney and ureter.
4. Interventions: If needed, blockages are removed, areas are irrigated or instilled with medication, or a ureteral catheter is placed for drainage.
5. Completion: Instruments are withdrawn, and the nephrostomy or pyelostomy tube is secured.

Tools include endoscopes, catheters, irrigation systems, and possibly dilation balloons.

Duration

The procedure typically takes 1-3 hours, depending on the intervention required.

Setting

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

Personnel

• Urologist or Surgeon
• Anesthesiologist
• Surgical Nurses
• Radiologic Technologists (if imaging is involved)

Risks and Complications

• Infection
• Bleeding
• Injury to the kidney or ureter
• Reaction to anesthesia
• Scar tissue formation leading to future blockages

Benefits

• Relief from symptoms like pain or infection
• Improved kidney function
• Accurate diagnosis of urinary tract issues
• Prevention of further damage to the urinary system Benefits are often realized immediately to a few days post-procedure.

Recovery

• Patients may stay in the hospital for observation or be discharged the same day.
• Pain management may include oral pain relievers.
• Patients should avoid strenuous activities for a few days.
• Follow-up appointments to monitor recovery and kidney function.

Alternatives

• Percutaneous nephrostomy alone without endoscopy
• Ureteroscopy through the bladder
• Medical management with antibiotics or medications
• Pros and Cons: Endoscopy offers direct visualization and intervention, but it is invasive compared to purely medical management.

Patient Experience

• Patients can expect some discomfort during recovery.
• Pain is typically managed with medication.
• There may be temporary changes in urination, including blood in the urine.
• Follow-up care is crucial for monitoring recovery and ensuring no complications arise.