Name of the Procedure:

Cystourethroscopy with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with brush biopsy of ureter and/or renal pelvis.

Summary

Cystourethroscopy with ureteral catheterization and brush biopsy is a procedure where a thin tube with a camera (cystourethroscope) is inserted through the urethra into the bladder and ureters to diagnose or treat urinary tract conditions. The brush biopsy involves collecting cells from the ureter or renal pelvis for examination.

Purpose

This procedure is performed to:

• Diagnose conditions affecting the ureter or renal pelvis.
• Collect tissue samples for microscopic examination to detect cancer, infections, or other abnormalities.
• Assist in comprehensive analysis of the urinary system.

Indications

• Persistent hematuria (blood in urine).
• Recurrent urinary tract infections.
• Unexplained urinary symptoms.
• Suspicion of ureteral or renal pelvis tumors or strictures.
• Abnormal imaging findings requiring further investigation.

Preparation

• Patients may need to fast for a certain period before the procedure.
• Adjustments in medications, particularly blood thinners, may be needed.
• Pre-procedure tests such as urinalysis or imaging studies.

Procedure Description

1. The patient is positioned, and sedation or anesthesia is administered.
2. The cystourethroscope is gently inserted through the urethra into the bladder, and further into the ureter.
3. Ureteral catheterization may be performed to allow for fluid instillation or contrast dye injection.
4. A small brush is used to collect cells from the ureter or renal pelvis.
5. Collected samples are sent for laboratory analysis.
6. The scope and catheter are then withdrawn.

Duration

Typically takes between 45 minutes to 1 hour.

Setting

Usually performed in a hospital, outpatient clinic, or a specialized urology center.

Personnel

• Urologist or urologic surgeon.
• Nurses or physician assistants.
• Anesthesiologist or nurse anesthetist (if sedation or anesthesia is used).

Risks and Complications

• Mild bleeding or discomfort during urination.
• Urinary tract infection.
• Rarely, urethral or ureteral injury.
• Potential allergic reaction to contrast dye or anesthesia.

Benefits

• Accurate diagnosis of urinary tract conditions.
• Early detection of malignancies or infections.
• Minimally invasive compared to more extensive surgeries.
• Quick turnaround time for diagnosis from biopsy samples.

Recovery

• Patients might experience mild discomfort or a burning sensation while urinating.
• Increased fluid intake is encouraged to flush the urinary system.
• Usually, normal activities can be resumed within a day, but avoid strenuous activities for a few days.
• Follow-up appointments to discuss biopsy results and any necessary further treatment.

Alternatives

• Imaging studies such as CT scans or MRI.
• Non-invasive urine tests.
• Less invasive methods may provide limited information compared to direct visualization and biopsy.

Patient Experience

Patients may feel pressure or discomfort during the procedure but typically no significant pain due to anesthesia or sedation. Post-procedure, some discomfort during urination is common. Adequate pain management and hydration usually mitigate these symptoms.