Name of the Procedure:

Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit

Summary

This procedure involves replacing a ureterostomy tube or a ureteral stent that has been accessed through an ileal conduit, which is a surgically created channel made from a piece of the small intestine to divert urine away from the bladder.

Purpose

The procedure addresses issues related to the malfunction or blockage of the ureterostomy tube or stent, which is essential for ensuring proper urine flow from the kidneys. The goal is to restore normal urinary function and prevent complications such as infections or kidney damage.

Indications

The procedure is indicated for patients experiencing blockages, infections, discomfort, or dysfunction of their existing ureterostomy tube or stent. It is also performed when a routine exchange of these tubes or stents is necessary due to wear or duration of use.

Preparation

• Patients may need to fast for a certain period before the procedure.
• Adjustments to medication, especially blood thinners, might be required.
• Pre-procedure tests could include blood work, urine analysis, and imaging studies like an ultrasound or CT scan.

Procedure Description

1. The patient is positioned appropriately, often lying down.
2. Local anesthesia or sedation is administered for comfort.
3. The old ureterostomy tube or stent is carefully removed.
4. The urinary conduit is inspected and possibly irrigated to clear any debris.
5. A new ureterostomy tube or stent is inserted through the ileal conduit and positioned correctly.
6. The placement is confirmed, often using imaging such as fluoroscopy.
7. The new device is securely anchored to prevent dislodgement.

The tools used include catheters, imaging equipment, and sterile surgical instruments.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

It is usually performed in a hospital or outpatient surgical center.

Personnel

• Urologist or surgeon
• Assisting nurses
• Anesthesiologist (if sedation or anesthesia is required)

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding structures
• Discomfort or pain
• Blockage or displacement of the new tube or stent

Benefits

• Restores proper urine flow from the kidneys.
• Reduces risk of infections and kidney damage.
• Immediate improvement in urinary function.

Recovery

• Patients may experience mild discomfort or soreness, which can usually be managed with pain relief medications.
• Instructions to keep the site clean and dry will be provided.
• Normal activities can often be resumed shortly, although lifting heavy objects and strenuous activities should be avoided for a few days.
• Follow-up appointments may be necessary to ensure the stent or tube is functioning correctly.

Alternatives

• Placement of a nephrostomy tube, which involves inserting a tube directly into the kidney.
• Conservative management with antibiotics for infections.
• Surgical revision of the conduit if recurrent issues arise.

Patient Experience

Patients might feel slight discomfort during the procedure, which is mitigated with local anesthesia or sedation. Afterward, mild soreness at the insertion site is common. Pain management, including medications and proper care of the insertion site, helps ensure comfort and quicker recovery.