50600 Ureterotomy with exploration or drainage (separate procedure)

Name of the Procedure:

Ureterotomy with exploration or drainage
Common name(s): Ureterotomy
Technical/medical term: Ureteral Exploration

Summary

Ureterotomy with exploration or drainage is a surgical procedure where an incision is made into the ureter to examine its interior or drain any obstruction. It's performed to diagnose or treat issues within the ureter, such as blockages or stones.

Purpose

The procedure addresses conditions like ureteral strictures, obstructions, or stones that could impede urine flow from the kidneys to the bladder. The goal is to restore normal urine flow, relieve pain, and prevent further complications such as infections or kidney damage.

Indications

• Recurrent urinary tract infections
• Severe, unrelievable pain due to ureteral obstruction
• Visible blood in urine (hematuria)
• Failure of nonsurgical treatments for ureteral stones or strictures
• Kidney function deterioration due to prolonged obstruction

Preparation

• Pre-procedure fasting typically for 6-8 hours.
• Medication adjustments, particularly blood thinners.
• Diagnostic tests such as CT scans, MRIs, urine tests, or blood tests.
• Preoperative evaluation to assess overall health and operative risk.

Procedure Description

1. The patient is given general anesthesia.
2. An incision is made in the abdomen or along the urinary tract to access the ureter.
3. The ureter is carefully opened to allow for examination or the removal of obstructions like stones; any necessary drainage is performed.
4. The ureter and surrounding area are inspected for any additional issues.
5. The ureter is sutured back together, and the incision is closed.
6. A stent may be placed in the ureter to ensure it remains open as it heals.

Tools: Scalpel, sutures, stent, laparoscopic instruments.
Anesthesia: General anesthesia.

Duration

The procedure typically takes 1-2 hours, depending on the complexity of the case.

Setting

Ureterotomy with exploration or drainage is performed in a hospital operating room or a specialized surgical center.

Personnel

• Urologist or surgical specialist
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding organs or tissues
• Urine leakage from the ureter
• Scar tissue formation leading to future obstructions
• Anesthetic risks

Benefits

• Relief from pain and discomfort
• Restoration of normal urine flow
• Prevention of kidney damage and recurrent infections

• Improved overall kidney function

  Benefits are typically realized shortly after recovery from surgery.

Recovery

• Hospital stay for 1-2 days post-procedure.
• Pain management with prescribed medications.
• Instructions on keeping the incision site clean and dry.
• Avoiding heavy lifting or strenuous activity for several weeks.
• Follow-up appointments for removal of any stent and monitoring recovery.

Alternatives

• Minimally invasive procedures like ureteroscopy or percutaneous nephrolithotomy.
• Non-surgical options such as medication to dissolve stones or dilate strictures.

• Shock wave lithotripsy to break down stones.

  Pros and cons:

• Minimally invasive options may have shorter recovery times but might not be suitable for all cases.
• Non-surgical methods may be less effective for large or complicated obstructions.

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel pain. After the procedure, patients may experience some discomfort or pain at the incision site, which can be managed with pain medications. There might be mild to moderate pain as the ureter heals, especially if a stent is placed. Following the surgeon's post-operative instructions ensures optimal healing and comfort.