Name of the Procedure:

Cystotomy for Excision, Incision, or Repair of Ureterocele

Summary

A cystotomy is a surgical procedure where the bladder is opened to access the ureterocele — a swelling or abnormality of the ureter. The procedure aims to excise (remove), incise (cut into), or repair the ureterocele to restore normal urinary function.

Purpose

This procedure addresses the presence of a ureterocele, which can cause urinary obstruction, infection, and kidney damage. The goal is to alleviate these issues, allowing for normal urine flow and reducing the risk of complications.

Indications

• Recurrent urinary tract infections
• Obstructed urine flow
• Vesicoureteral reflux (backflow of urine into the kidneys)
• Bladder or kidney pain
• Evidence of kidney damage

Preparation

• Patients may be required to fast for several hours before the procedure.
• Adjustments to medications might be necessary, especially blood thinners.
• Pre-operative tests such as blood tests, urinalysis, and imaging studies (e.g., ultrasound, CT scan) will be conducted to assess the ureterocele.

Procedure Description

1. The patient is administered general anesthesia to ensure they are pain-free and asleep during the surgery.
2. A small incision is made in the lower abdomen to access the bladder.
3. Once the bladder is opened, the surgeon identifies the ureterocele.
4. The ureterocele is then excised, incised, or repaired using specialized surgical tools.
5. If excised, the abnormal portion of the ureter is removed.
6. The bladder is then sutured closed, and the abdominal incision is sealed.
7. A catheter may be placed to drain urine from the bladder during recovery.

Duration

The procedure typically takes 1 to 2 hours.

Setting

Performed in a hospital or surgical center with access to necessary medical equipment and personnel.

Personnel

• Surgeon (typically a urologist)
• Anesthesiologist
• Surgical nurses
• Operating room technician

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding organs or structures
• Urinary incontinence
• Postoperative pain
• Risk of anesthesia-related complications

Benefits

• Relief from obstruction and urinary symptoms
• Reduced risk of recurrent infections
• Prevention of kidney damage
• Improved urinary flow and bladder function Benefits can often be noticed shortly after recovery, although complete healing may take several weeks.

Recovery

• Patients may need to stay in the hospital for 1 to 2 days post-procedure.
• Pain management with prescribed medications.
• Limited physical activity and avoidance of heavy lifting for a few weeks.
• Typically, the catheter remains in place for several days.
• Follow-up appointments to monitor healing and ensure proper urinary function.

Alternatives

• Endoscopic incision of the ureterocele (less invasive)
• Ureteral stent placement
• Long-term monitoring and medical management of symptoms Each alternative has its own advantages and disadvantages. Less invasive procedures may have shorter recovery times but might not be as effective in severe cases.

Patient Experience

During the procedure, patients are under general anesthesia and will not feel pain. Following the surgery, they might experience discomfort or pain, which can be managed with medications. Most patients report significant improvement in their symptoms once they have fully recovered.