Name of the Procedure:

Ureteral Endoscopy through Established Ureterostomy with Biopsy (With or Without Irrigation, Instillation, or Ureteropyelography)

Summary

A ureteral endoscopy through an established ureterostomy is a medical procedure where a thin, flexible tube with a camera (endoscope) is inserted into the ureter via an existing opening (ureterostomy). This procedure can include irrigation (flushing), instillation (injection of medication), or ureteropyelography (imaging of the ureter and renal pelvis). A biopsy may be taken during the procedure to collect tissue samples for diagnostic purposes.

Purpose

The procedure is used to diagnose and assess conditions within the ureter and kidney, such as obstructions, strictures, tumors, or infections. The biopsy helps in identifying specific diseases or abnormalities by analyzing tissue samples.

Indications

• Persistent urinary tract infections
• Hematuria (blood in urine)
• Suspected tumors or abnormal growths
• Ureteral or renal obstructions
• Follow-up on previously diagnosed conditions

Preparation

• Fasting for several hours before the procedure may be required.
• Medications might need to be adjusted, especially blood thinners.
• Pre-procedure diagnostic tests such as urine analysis, blood tests, and imaging studies may be necessary.

Procedure Description

1. The patient is prepped and possibly given anesthesia or sedation.
2. The endoscope is inserted into the ureter through the ureterostomy.
3. The physician inspects the ureter and the renal pelvis using the camera on the endoscope.
4. Irrigation, instillation, or ureteropyelography may be performed if needed.
5. A small tissue sample (biopsy) is taken using specialized instruments passed through the endoscope.
6. The endoscope is carefully removed, and the patient is monitored during recovery.

Tools and equipment: Endoscope, irrigation or instillation fluids, biopsy forceps. Anesthesia: Local, regional, or general anesthesia depending on the patient and exact procedure.

Duration

The procedure typically takes 30 minutes to 1 hour.

Setting

It is performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Urologist (surgeon specialized in urinary tract system)
• Nurses
• Anesthesiologist (if sedation or general anesthesia is used)

Risks and Complications

• Infection
• Bleeding
• Injury to the ureter
• Adverse reaction to anesthesia or sedation
• Stricture formation at the ureterostomy site

Benefits

• Accurate diagnosis of ureteral and renal conditions
• Early detection of potentially serious conditions like cancer
• Minimally invasive with quick recovery

Recovery

• Patients may be monitored for a brief period post-procedure.
• Instructions may include drinking plenty of fluids, avoiding strenuous activities, and watching for signs of infection.
• Recovery time is usually short, with most patients resuming normal activities within a few days.

Alternatives

• Non-invasive imaging studies (e.g., ultrasound, MRI, or CT scan)
• Open surgical biopsy Pros and cons: Imaging studies are less invasive but may not provide tissue samples; open surgical biopsy is more invasive with longer recovery.

Patient Experience

• During the procedure, the patient might feel mild discomfort or pressure.
• After the procedure, there might be mild pain or burning during urination, managed with pain medication.
• Patients are encouraged to rest and stay hydrated to aid recovery.