Name of the Procedure:

Ureterolysis, with or without repositioning of ureter, for retroperitoneal fibrosis

Summary

Ureterolysis is a surgical procedure aimed at freeing a ureter (the tube that carries urine from the kidney to the bladder) from surrounding fibrous tissue or scar tissue caused by a condition known as retroperitoneal fibrosis. This procedure may involve repositioning the ureter to prevent future obstructions.

Purpose

The procedure addresses retroperitoneal fibrosis, a rare condition where fibrous tissue develops behind the lining of the abdominal cavity and entraps the ureters. The goal is to relieve ureteral obstruction, restore normal urinary flow, and prevent possible kidney damage.

Indications

• Persistent back or flank pain
• Hydronephrosis (swelling of the kidney due to urine buildup)
• Recurrent urinary tract infections
• Decreased kidney function revealed by imaging or lab tests
• Patients diagnosed with retroperitoneal fibrosis through imaging studies

Preparation

• Patients are typically instructed to fast for 8 hours before the procedure.
• Blood and urine tests, imaging studies (like CT or MRI scans), and possibly a kidney function test may be required.
• Patients may need to stop certain medications, especially blood thinners, as instructed by their healthcare provider.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: A surgical cut is made in the abdomen to access the affected ureter.
3. Ureterolysis: The surgeon carefully dissects the fibrous tissue surrounding the ureter to free it.
4. Repositioning: If necessary, the ureter is repositioned to prevent recurrence of obstruction. This may involve placing the ureter in a new position within the body cavity.
5. Stents: Temporary stents may be inserted in the ureter to keep it open during healing.
6. Closure: The incision is closed with sutures or surgical staples.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity and the extent of fibrosis.

Setting

Ureterolysis is performed in a hospital operating room.

Personnel

• Surgeon (usually a urologist)
• Anesthesiologist
• Surgical nurses
• Support staff (e.g., surgical technician)

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding organs or tissues
• Urinary leakage
• Blood clots
• Scarring
• Need for additional surgeries
• Complications from anesthesia

Benefits

• Relief of symptoms such as pain and urinary obstruction
• Prevention of further kidney damage
• Improvement in overall kidney function Patients often start to notice benefits within a few weeks after surgery.

Recovery

• Hospital stay: Usually 3 to 5 days.
• Post-procedure: Patients will have a catheter to drain urine and may have stents in place temporarily.
• Restrictions: Avoid heavy lifting and strenuous activity for several weeks.
• Follow-up appointments: Necessary to monitor healing, remove stents, and ensure the ureters remain open.
• Full recovery: Typically 4 to 6 weeks with gradual return to normal activities.

Alternatives

• Medications: Steroids or immunosuppressive drugs to reduce inflammation.
• Minimally invasive procedures: Such as laparoscopic ureterolysis, which involves smaller incisions.
• Observation: Monitoring without immediate intervention if symptoms are mild.
• Pros and cons: Medications may not always be effective and can have side effects, while minimally invasive procedures offer quicker recovery but may not be suitable for severe fibrosis.

Patient Experience

• During the procedure: The patient will be under general anesthesia and will not be aware or feel pain.
• After the procedure: Pain at the incision site managed through pain medications. Discomfort from urinary catheters or stents, which should improve as healing progresses.
• Pain management: Regular administration of prescribed pain relievers and use of supportive measures like ice packs or comfortable positioning.