Name of the Procedure:

Ureteral Endoscopy through Established Ureterostomy, with or without irrigation, instillation, or ureteropyelography; with Ureteral Catheterization, with or without dilation of Ureter

Summary

This procedure involves using an endoscope to examine and treat the ureter via an existing ureterostomy. It may include flushing the ureter, injecting substances, performing an X-ray examination, and inserting or enlarging a catheter to ensure urine flow.

Purpose

This procedure addresses blockages, stones, or strictures in the ureter. The goal is to diagnose and treat any issues, ensure proper urine flow, and relieve symptoms such as pain or infection.

Indications

• Recurrent urinary tract infections
• Ureteral obstructions or strictures
• Hematuria (blood in urine)
• Previous findings from imaging studies indicating abnormalities in the ureter
• Difficulty in urine drainage despite a ureterostomy

Preparation

• Patients may need to fast for several hours before the procedure.
• Medication adjustments could be necessary, particularly anticoagulants.
• Baseline blood tests and imaging studies may be required for evaluation.

Procedure Description

1. The patient is positioned appropriately, and anesthesia is administered (local, regional, or general based on the case).
2. An endoscope is inserted through the established ureterostomy.
3. The ureter is inspected and, if needed, flushed with a solution (irrigation).
4. Substances may be instilled to treat or diagnose conditions in the ureter.
5. For ureteropyelography, a contrast dye may be injected, and X-ray images taken to examine the ureter and kidney.
6. A ureteral catheter is inserted to facilitate urine drainage, which may involve dilating the ureter if it is narrowed.

Duration

The procedure typically takes 30 to 60 minutes, depending on its complexity.

Setting

The procedure is generally performed in a hospital operating room or an outpatient surgical center.

Personnel

• Urologist or endoscopic surgeon
• Nurses
• Anesthesiologist or nurse anesthetist
• Radiology technician (if imaging is involved)

Risks and Complications

• Infection
• Bleeding
• Injury to the ureter or kidney
• Adverse reactions to anesthesia
• Postoperative pain
• Rarely, stricture formation or reblockage

Benefits

• Relief from obstructive symptoms and pain
• Accurate diagnosis of ureteral conditions
• Improved urinary function
• Reduced risk of recurrent infections

Recovery

• Post-procedure monitoring for a few hours.
• Instructions on fluid intake and activity restrictions.
• Possible antibiotic course to prevent infection.
• Follow-up visits for catheter removal or assessment of the ureter.

Alternatives

• Conservative management with medication
• Ureteral stenting without endoscopy
• Open surgical repair of ureteral strictures
• Percutaneous nephrostomy for urine drainage

Patient Experience

• Mild discomfort at the ureterostomy site during the procedure.
• Sedation or anesthesia minimizes pain.
• Possible mild pain or discomfort post-procedure, managed with pain medication.
• Normal activities can generally resume within a few days, barring any complications.