Name of the Procedure:

Ureterolysis for Ovarian Vein Syndrome
(Common names: Ureterolysis)

Summary

Ureterolysis is a surgical procedure aimed at freeing the ureter from any compression or abnormal tissue, particularly aimed at resolving issues caused by ovarian vein syndrome, which can lead to ureteral obstruction.

Purpose

This procedure addresses the compression of the ureter due to an enlarged ovarian vein, which can cause pain, discomfort, and impaired kidney function. The goal is to relieve this compression, restore normal urine flow, and alleviate symptoms such as flank pain and urinary issues.

Indications

• Chronic flank pain without an apparent cause
• Recurrent urinary tract infections
• Obstructive uropathy where imaging studies show compression from the ovarian vein
• Hydronephrosis (swelling of the kidney due to urine build-up)

Preparation

• Patients may be instructed to fast for 6-8 hours before the procedure.
• Adjustments to medications such as blood thinners may be required.
• Preoperative imaging tests like CT scans or MRIs may be required to confirm the diagnosis and plan the surgery.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: A small incision is made laparoscopically or through an open approach to access the ureter.
3. Dissection: The surgeon carefully dissects surrounding tissues to expose the ureter.
4. Freeing the Ureter: The ureter is freed from any compressive tissue, particularly the ovarian vein causing the obstruction.
5. Possible additional steps: A stent may be temporarily placed inside the ureter to ensure it remains open during healing.
6. Closure: The incision is closed with sutures or surgical staples.

Tools used: Laparoscope (for minimally invasive approach), surgical scalpel, tissue retractors, ureteral stent.

Duration

The procedure typically takes about 1-3 hours, depending on the complexity and whether it's performed laparoscopically or through open surgery.

Setting

The procedure is usually performed in a hospital operating room.

Personnel

• A urologist or a general surgeon specialized in pelvic surgery
• An anesthesiologist
• Surgical nurses
• Scrub technicians

Risks and Complications

• Infection at the surgical site
• Bleeding
• Injury to surrounding organs or tissues
• Ureteral stricture (narrowing) or persistent obstruction
• Blood clots
• Complications related to anesthesia

Benefits

• Relief from chronic flank pain and discomfort
• Improved urine flow and kidney function
• Reduction in the frequency of urinary tract infections
• Potentially reduced risk of long-term kidney damage

Recovery

• Patients may stay in the hospital for 1-2 days post-surgery.
• Pain management includes prescribed pain relievers.
• Patients are encouraged to avoid heavy lifting and strenuous activities for several weeks.
• Follow-up appointments may include imaging studies to ensure the ureter is healing properly.
• Full recovery time varies but typically spans 4-6 weeks.

Alternatives

• Conservative management with pain relief and observation
• Endovascular procedures like vein embolization
• Ureteral stent placement without surgical decompression
• Nephrostomy tube (for temporary urine diversion in severe cases)

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Postoperatively, patients may experience mild to moderate pain at the incision site and some discomfort from the ureteral stent if one is placed. Pain management strategies, such as medications and possibly physical therapy, will be employed to ensure patient comfort.