Name of the Procedure:

Ureteral Endoscopy through Established Ureterostomy, with or without Irrigation, Instillation, or Ureteropyelography, Exclusive of Radiologic Service; with Fulguration and/or Incision, with or without Biopsy

Summary

Ureteral endoscopy through an established ureterostomy is a minimally invasive procedure that allows a doctor to look inside the ureter using a thin, flexible tube called an endoscope. This procedure can include washing out the ureter, applying medication, performing imaging, cauterizing (burning) abnormal tissue, making incisions, or taking tissue samples.

Purpose

Medical Condition/Problem

This procedure addresses issues within the ureter such as blockages, strictures (narrowing), tumors, or stones.

Goals

• To remove or treat blockages in the ureter.
• To obtain tissue samples for biopsy to diagnose any abnormality.

Indications

• Symptoms of urinary obstruction, such as pain, difficulty urinating, or recurrent urinary tract infections.
• Diagnosis of abnormal lesions or masses seen in prior imaging.
• Patients with an established ureterostomy requiring evaluation or treatment of the ureter.

Preparation

• Patients may need to fast for several hours before the procedure.
• Certain medications, especially blood thinners, may need to be paused.
• Pre-procedure testing may include blood tests and imaging studies to assess the urinary system.

Procedure Description

1. Anesthesia is administered, usually general or regional, to ensure the patient is comfortable.
2. The endoscope is gently inserted through the established ureterostomy.
3. The doctor examines the inside of the ureter.
4. Irrigation may be used to flush the area, and special solutions may be instilled.
5. Ureteropyelography, a type of imaging, might be performed to visualize the ureter and renal pelvis.
6. Fulguration (cauterizing abnormal tissue) or small incisions may be made to treat strictures or remove obstructions.
7. Biopsies can be taken if suspicious tissues are found.
8. The endoscope is carefully withdrawn, and the procedure is completed.

Duration

The procedure typically takes between 30 minutes to 1 hour, depending on the complexity.

Setting

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

Personnel

• Urologist: Performs the procedure.
• Anesthesiologist: Manages anesthesia.
• Nursing staff: Assists during the procedure and provides pre- and post-operative care.

Risks and Complications

Common Risks

• Mild bleeding.
• Infection. ##### Rare Risks
• Injury to the ureter.
• Allergic reactions to medication or anesthesia. ##### Management Complications can usually be managed with medication or additional procedures, if necessary.

Benefits

• Relief from symptoms caused by urinary obstruction.
• Accurate diagnosis of conditions affecting the ureter.
• Minimally invasive, leading to faster recovery.

Recovery

• Most patients can go home the same day or after a short hospital stay.
• Instructions include drinking plenty of fluids, taking prescribed medications, and monitoring for signs of infection.
• Full recovery typically takes a few days to a week.
• Follow-up appointments to monitor the patient's progress are usually required.

Alternatives

• Open surgery: More invasive with a longer recovery period.
• Observation: Monitoring the condition if it’s not causing severe symptoms.
• Imaging studies: For further evaluation, though not therapeutic.

Patient Experience

During the Procedure

• The patient will be under anesthesia and should not feel pain. ##### After the Procedure
• Mild discomfort or a burning sensation when urinating.
• Pain management is typically achieved with oral pain relievers.
• Patients are encouraged to rest and avoid strenuous activities for a few days.

By following these instructions and understanding what to expect, patients can approach the procedure with confidence and awareness.