Name of the Procedure:

Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus.

Summary

This procedure involves using a specialized scope to inspect the ureter, the tube that carries urine from the kidneys to the bladder, through an established surgical opening (ureterostomy). It can also involve washing out the area, administering medication, or taking X-ray images to better understand the condition. If there's a foreign body or kidney stones (calculus) present, they can be removed during the procedure.

Purpose

The procedure addresses the removal of foreign bodies or kidney stones lodged in the ureter. The goal is to clear blockages, reduce discomfort, and prevent complications such as infections or kidney damage.

Indications

• Severe pain due to kidney stones.
• Obstruction of the ureter.
• Infections caused by foreign bodies.
• Previous kidney stone treatments have failed.
• Presence of other palpable abnormalities in the ureter.

Preparation

• Fasting for at least 8 hours prior to the procedure.
• Adjustments or cessation of certain medications as advised by the doctor.
• Blood tests and imaging studies like ultrasound or CT scan.

Procedure Description

1. The patient is sedated or given general anesthesia.
2. A ureteroscope is inserted through the established ureterostomy to visualize the inside of the ureter.
3. Irrigation may be used to clear the view.
4. If a foreign body or kidney stone is detected, specialized tools are used to remove it.
5. Medication may be instilled to prevent infection and aid healing.
6. The area is examined for any residual debris or issues.
7. The scope is removed, and the opening is checked for proper closure.

Duration

The procedure typically takes about 30 minutes to an hour, depending on the complexity.

Setting

It is usually performed in a hospital or outpatient surgical center.

Personnel

• Urologist or surgeon.
• Anesthesiologist or nurse anesthetist.
• Surgical nurses and technical staff.

Risks and Complications

• Infection at the ureterostomy site.
• Injury to the ureter or surrounding tissues.
• Bleeding or blood clots.
• Rarely, complications from anesthesia.
• Residual fragments of the calculus remaining.

Benefits

• Relief from pain and discomfort.
• Removal of blockages allowing for normal urine flow.
• Decreased risk of infection and kidney damage.
• Improved kidney function over time.

Recovery

• Observation in the recovery area until effects of anesthesia wear off.
• Possible prescribed pain relievers and antibiotics.
• Hydration and specific fluid intake instructions.
• Avoiding strenuous activity for a few days.
• Follow-up appointments to monitor healing.

Alternatives

• Extracorporeal Shock Wave Lithotripsy (ESWL).
• Percutaneous nephrolithotomy.
• Medication to dissolve stones (depending on the type of stone and its size).
• Pros of alternatives include non-invasiveness (ESWL), but may also require multiple sessions or not be suitable for all types of stones.

Patient Experience

Patients might experience discomfort at the ureterostomy site and potential pain managed with prescribed medications. Short-term pain relief can usually be expected shortly after the procedure, with full recovery often occurring within a few weeks.