50951 Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service

Name of the Procedure:

Ureteral Endoscopy through Established Ureterostomy

• Common names: Ureteroscopic examination, Ureteral stent check
• Technical terms: Ureteroscopy, Ureteropyeloscopy

Summary

Ureteral endoscopy through an established ureterostomy is a medical procedure where a thin, flexible tube called an endoscope is inserted through an existing surgical opening in the ureter (ureterostomy). This allows the doctor to view the inside of the ureter and kidney, and perform tasks like irrigation, applying medication, or taking X-ray images (ureteropyelography).

Purpose

This procedure helps diagnose and treat conditions affecting the ureter and kidney:

• Identifying blockages or stones.
• Evaluating and treating infections or tumors.
• Monitoring the ureter and kidney following previous surgeries or interventions.

Indications

• Recurrent urinary tract infections
• Blood in the urine (hematuria)
• Unexplained pain in the lower back or abdomen
• Suspected kidney stones or tumors
• Follow-up after reconstructive surgery on the urinary tract

Preparation

• Fasting is generally not required unless anesthesia is used.
• Adjustments to regular medications may be needed, particularly blood thinners.
• Pre-procedure diagnostics may include urine tests, blood tests, and imaging studies.

Procedure Description

1. The patient is positioned comfortably, and sedation or anesthesia may be administered if necessary.
2. The endoscope is gently inserted through the established ureterostomy.
3. The doctor examines the inside of the ureter and kidney, making note of any abnormalities.
4. Irrigation fluid may be used to clear the area for better viewing.
5. Medication can be applied directly to the affected area if needed.
6. Ureteropyelography involves injecting a contrast dye and taking X-rays to get detailed images.
7. The endoscope is carefully removed once the procedure is complete.

Duration

The procedure typically takes about 30 to 60 minutes, depending on the complexity of the case.

Setting

This procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• Urologist (performing the procedure)
• Nurses (assisting with the procedure and patient care)
• Anesthesiologist (if sedation or general anesthesia is used)

Risks and Complications

• Infection
• Bleeding
• Injury to the ureter or kidney
• Allergic reaction to the contrast dye
• Need for further surgical intervention

Benefits

• Accurate diagnosis and effective treatment of ureteral and kidney conditions.
• Relief from symptoms like pain and recurrent infections.
• Improved kidney function and overall urinary health.

Recovery

• Patients can usually go home the same day.
• Mild discomfort or blood in the urine may be experienced for a few days.
• Drink plenty of fluids to help flush the urinary system.
• Follow-up appointments may be necessary to monitor recovery.

Alternatives

• Imaging studies alone (ultrasound, CT scan, MRI): Provides diagnostic information but not therapeutic intervention.
• Open surgery: More invasive, with longer recovery times but sometimes necessary for complex cases.
• Non-surgical management: Medications or watchful waiting, depending on the condition.

Patient Experience

• Mild discomfort during the procedure.
• Sedation often helps alleviate anxiety and discomfort.
• Post-procedure, patients might feel a slight burning sensation during urination or have some blood in the urine, which typically resolves in a few days. Pain management strategies and comfort measures will be provided as necessary.