Name of the Procedure:

Cystourethroscopy; with resection or fulguration of orthotopic ureterocele(s), unilateral or bilateral

Summary

Cystourethroscopy with resection or fulguration of a ureterocele is a minimally invasive procedure where a tube with a camera is inserted into the bladder and urethra to inspect and treat a ureterocele. A ureterocele is a congenital condition where the ureter (the tube that carries urine from the kidneys to the bladder) swells at its opening into the bladder, potentially causing kidney and urinary problems. The procedure can be done on one or both sides (unilateral or bilateral).

Purpose

This procedure addresses the problem of orthotopic ureterocele, a swelling in the part of the ureter that enters the bladder. The goals are to improve urinary flow, prevent urinary tract infections, and preserve kidney function by resecting (cutting out) or fulgurating (burning away) the ureterocele.

Indications

• Recurrent urinary tract infections (UTIs)
• Urinary obstruction
• Vesicoureteral reflux (backward flow of urine into the kidneys)
• Renal damage or hydronephrosis (swelling of the kidney due to urine buildup)

Preparation

• Fasting for 6-8 hours before the procedure
• Adjusting medications as advised by the doctor (e.g., stopping blood thinners)
• Undergoing diagnostic tests such as ultrasound, CT scan, or MRI to assess the ureterocele

Procedure Description

1. The patient is given anesthesia (general or regional) to ensure comfort.
2. A cystoscope (a thin tube with a camera) is inserted through the urethra into the bladder.
3. The ureterocele is identified using the camera.
4. Depending on the condition, the ureterocele is either resected or fulgurated.
   • Resection involves cutting and removing part of the swelling.
   • Fulguration uses electricity or laser to burn away the abnormal tissue.
5. The instruments are removed, and the patient is taken to recovery.

Duration

The procedure typically takes about 30 minutes to 1 hour.

Setting

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

Personnel

• Urologist or specialized surgeon
• Anesthesiologist
• Nurses and surgical technicians

Risks and Complications

• Infection
• Bleeding
• Injury to the bladder or ureter
• Stricture (narrowing) of the ureter
• Persistent or recurrent ureterocele

Benefits

• Improved urinary flow
• Reduction in UTIs
• Preservation of kidney function
• Relief of symptoms associated with urinary obstruction

Recovery

• Short-term hospitalization or outpatient recovery
• Pain management with prescribed medications
• Drinking plenty of fluids to flush the urinary system
• Avoiding strenuous activities for a few days
• Follow-up appointments to monitor recovery

Alternatives

• Watchful waiting with regular monitoring
• Antibiotic prophylaxis for recurrent UTIs
• More invasive surgical options like open ureteral reimplantation
• Pros of alternatives include potentially avoiding surgery; cons include persistent symptoms and risk of complications.

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Post-procedure, some discomfort, mild pain or burning sensation during urination, and possible blood in the urine are expected. Pain relief and comfort measures, such as recommended painkillers and drinking plenty of fluids, will be provided to manage these symptoms.