Name of the Procedure:

Cystourethroscopy (including ureteral catheterization); with removal of ureteral calculus

Summary

Cystourethroscopy with ureteral catheterization and removal of ureteral calculus is a minimally invasive procedure where a healthcare provider uses a specialized camera to view the interior of the bladder and urethra, place a catheter into the ureter, and remove stones from the ureter.

Purpose

This procedure is commonly performed to address the presence of ureteral calculi (stones) that are blocking urine flow or causing significant pain. The goal is to relieve obstruction, alleviate pain, and prevent potential damage to the kidneys.

Indications

• Severe pain due to ureteral stones
• Blood in the urine (hematuria)
• Urinary tract infections (UTIs) related to the stones
• Difficulty passing urine due to obstructions

Preparation

• Patients may need to fast for several hours before the procedure.
• Pre-procedure imaging tests like a CT scan or ultrasound may be required to locate the stone.
• Patients should inform their healthcare provider about any medications they are taking, as some may need to be paused.

Procedure Description

1. The patient is given anesthesia (usually general or regional).
2. A cystoscope (a thin, flexible camera) is inserted through the urethra into the bladder.
3. The healthcare provider examines the bladder and urethra.
4. A catheter with a specialized tool (ureteroscope) is threaded through the cystoscope into the ureter.
5. The ureteral calculus is located and removed using tools like laser fibers or grasping baskets.
6. The instruments are withdrawn, and a temporary stent might be placed to ensure urine flow.

Duration

The procedure typically takes between 30 minutes to 2 hours, depending on the complexity and size of the stones.

Setting

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

Personnel

• Urologist (surgeon specializing in urinary tract conditions)
• Nurses
• Anesthesiologist

Risks and Complications

• Infection
• Bleeding
• Ureteral injury or perforation
• Temporary urinary discomfort or urgency
• Rarely, severe complications like kidney damage

Benefits

• Relief from pain caused by ureteral stones
• Restoration of normal urine flow
• Prevention of kidney damage
• Typically, patients can notice symptom relief soon after the removal of stones.

Recovery

• Patients may experience mild discomfort or blood-tinged urine for a few days.
• Drinking plenty of water is advised to flush out any remaining stone fragments.
• Pain medications may be prescribed.
• Follow-up appointments and imaging tests may be scheduled to ensure no residual stones remain.

Alternatives

• Extracorporeal shock wave lithotripsy (ESWL)
• Medical therapy to dissolve the stones
• Open or laparoscopic surgery in more severe cases
• Pros and Cons of Alternatives: Non-invasive methods like ESWL avoid surgery but may not be effective for all stones. Surgery is more invasive but removes stones directly.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Post-procedure, there might be some discomfort, a sensation of needing to urinate frequently, and possibly mild pain managed with medications. Comfort measures include adequate hydration and resting as needed. Follow-up care is vital for monitoring success and addressing any issues.