Name of the Procedure:

Balloon Dilation of Ureteral Stricture with Imaging Guidance (e.g., Ultrasound and/or Fluoroscopy) and Radiological Supervision and Interpretation

Summary

In layman's terms, balloon dilation of a ureteral stricture is a medical procedure used to widen a narrowed section of the ureter — the tube that carries urine from the kidney to the bladder. This is achieved by inflating a small balloon at the site of the narrowing. The procedure uses imaging techniques such as ultrasound or fluoroscopy for guidance.

Purpose

This procedure addresses ureteral strictures, which are narrowings or blockages in the ureter that can cause significant problems such as pain and urinary retention. The goal is to widen the narrowed portion of the ureter to allow urine to flow freely from the kidney to the bladder, alleviating symptoms and preventing further complications.

Indications

• Persistent flank pain
• Recurrent urinary tract infections
• Hydronephrosis (swelling of a kidney due to urine build-up)
• Unsuccessful outcomes from less invasive treatments
• Obstructive uropathy (blockage of urine flow)

Preparation

• Fasting for a specified period, usually 6-8 hours before the procedure
• Adjustment or temporary discontinuation of certain medications, particularly blood thinners
• Pre-procedure imaging tests such as an ultrasound, CT scan, or MRI may be required

Procedure Description

1. The patient is positioned on the procedure table, often under the influence of local or general anesthesia.
2. Imaging guidance is used to navigate and locate the ureteral stricture.
3. A guidewire is first inserted into the ureter through the urinary tract.
4. A catheter with a deflated balloon at its tip is then threaded over the guidewire to the site of the stricture.
5. The balloon is carefully inflated to a predetermined pressure to dilate the stricture.
6. Once the stricture has been adequately widened, the balloon is deflated and removed.
7. Post-procedure imaging is performed to confirm successful dilation.

Duration

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

Setting

This procedure is usually performed in a hospital's radiology department, surgical center, or an outpatient clinic equipped with fluoroscopy or ultrasound facilities.

Personnel

• Interventional radiologist or urologist
• Radiologic technologist
• Nursing staff
• Anesthesiologist, if general anesthesia is used

Risks and Complications

• Infection
• Bleeding
• Perforation of the ureter
• Recurrence of the stricture
• Allergic reaction to contrast dye used for imaging

Benefits

The expected benefits include relief from symptoms such as pain, improved urine flow, and prevention of kidney damage. Many patients notice significant improvement within a few days of the procedure.

Recovery

• Monitoring in a recovery area for a few hours post-procedure
• Instructions for hydration and possibly medication to prevent infection or pain
• Usually a same-day discharge if no complications arise
• Avoiding strenuous activities for a few days
• Follow-up appointments to monitor for recurrence or complications

Alternatives

• Ureteral stent placement: Involves placing a tube to keep the ureter open.
• Surgical ureter reconstruction: More invasive, but may be necessary if dilation fails.
• Laser or cold knife incision of the stricture: Another minimally invasive approach.

Patient Experience

During the procedure, patients will typically be under anesthesia and shouldn't feel pain. Post-procedure, there might be some discomfort or mild pain at the site, which can be managed with prescribed pain relief. Normal activity can usually be resumed within a few days with specific post-procedure care instructions provided by the healthcare team.