Name of the Procedure:

Renal Endoscopy through Nephrotomy or Pyelotomy
(Common Names: Kidney Endoscopy, Renal Pelvis Endoscopy)

Summary

Renal endoscopy through nephrotomy or pyelotomy is a medical procedure that allows doctors to view and treat conditions in the kidney and its drainage system using a special scope. The procedure can involve irrigation, instillation of medication, or imaging of the urinary tract, but does not include radiologic services.

Purpose

This procedure addresses conditions within the kidney and its drainage system, such as blockages, stones, or tumors. The goals include diagnosing and treating these problems to restore normal kidney function and alleviate symptoms.

Indications

• Persistent kidney stones
• Tumors in the kidney or renal pelvis
• Urinary tract abnormalities
• Obstructions in the urinary drainage system
• Recurrent urinary tract infections
• Hematuria (blood in urine) of unknown origin

Preparation

• Fasting for at least 6-8 hours before the procedure
• Adjustments to medications as advised by the healthcare provider
• Blood tests, urine tests, and imaging studies to assess kidney function and anatomy

Procedure Description

1. Anesthesia: The patient is administered general anesthesia.
2. Incision: A small incision is made in the patient’s flank to access the kidney.
3. Nephrotomy/Pyelotomy: Through this incision, the kidney or renal pelvis is opened.
4. Endoscopy: A flexible or rigid endoscope is inserted to visualize internal structures.
5. Treatment/Intervention: Any necessary procedures such as stone removal, tumor biopsy, or treatment of obstructions are performed.
6. Irrigation/Instillation: The area may be irrigated, and medications may be instilled to prevent infection or aid healing.
7. Closure: The nephrotomy or pyelotomy site is sutured, and the external incision is closed.

Duration

Typically, the procedure takes about 1-3 hours, depending on its complexity.

Setting

Performed in a hospital or surgical center with appropriate facilities for general anesthesia and post-operative care.

Personnel

• Urologist or renal surgeon
• Anesthesiologist
• Surgical nurses
• Often, a radiology technician (if intra-operative imaging is required)

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding organs or tissues
• Scar tissue formation
• Temporary or permanent impairment of kidney function

Benefits

• Relief from symptoms caused by kidney stones, tumors, or obstructions
• Improved kidney function
• Prevention of recurrent urinary tract infections or other complications
• Accurate diagnosis and targeted treatment of kidney conditions

Recovery

• Hospital stay of 1-2 days for observation and initial recovery
• Pain management with prescribed medications
• Instructions to avoid heavy lifting and strenuous activities for several weeks
• Follow-up appointments to monitor healing and kidney function

Alternatives

• Extracorporeal shock wave lithotripsy (ESWL) for kidney stones
• Percutaneous nephrolithotomy (PCNL)
• Open renal surgery
• Conservative management with medications and lifestyle modifications

Patient Experience

During the procedure, patients will be under general anesthesia and will not feel pain. Post-operatively, patients might experience some pain at the incision site, mild discomfort, and will typically receive pain management. They can expect a gradual return to normal activities over several weeks, with specific instructions given by the healthcare provider.