52325 Cystourethroscopy (including ureteral catheterization); with fragmentation of ureteral calculus (eg, ultrasonic or electro-hydraulic technique)

Name of the Procedure:

Cystourethroscopy with Ureteral Catheterization and Fragmentation of Ureteral Calculus
Common names: Cystoscopy with stone fragmentation, Ureteroscopy for stone removal

Summary

Cystourethroscopy with fragmentation of ureteral calculus is a minimally invasive procedure where a doctor uses a small camera to look inside the bladder and urethra, then breaks down kidney stones in the ureter using techniques such as ultrasonic or electro-hydraulic methods.

Purpose

This procedure addresses the presence of kidney stones (ureteral calculi) stuck in the ureter. The goals are to relieve pain, prevent infection, and avoid kidney damage by removing or fragmenting the stones so they can be naturally expelled from the body.

Indications

• Severe pain in the side, back, or lower abdomen (flank pain)
• Blood in the urine (hematuria)
• Recurrent urinary tract infections (UTIs)
• Blockage of urine flow resulting in hydronephrosis
• Stones that are too large to pass on their own

Preparation

• Fasting for a specified period before the procedure
• Adjustments to current medications as advised by the medical team
• Pre-procedure imaging tests such as X-rays or CT scans to locate the stones

Procedure Description

1. The patient is given anesthesia (general or regional).
2. A cystoscope is inserted through the urethra to the bladder.
3. A smaller scope (ureteroscope) may be advanced into the ureter.
4. Stones are located using the camera.
5. Stone fragmentation is performed using techniques like ultrasonic or electro-hydraulic lithotripsy.
6. Fragmented stone pieces are either removed with a basket or allowed to pass naturally.
7. Catheters may be placed to assist with urine flow post-procedure.

Duration

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

Setting

Performed in a hospital or an outpatient surgical center.

Personnel

• Urologist (surgeon)
• Nursing staff
• Anesthesiologist or nurse anesthetist

Risks and Complications

• Infection
• Bleeding
• Injury to the ureter or bladder
• Incomplete stone fragmentation necessitating additional procedures
• Urinary retention
• Rarely, damage to surrounding organs

Benefits

• Relief from pain and other symptoms caused by kidney stones
• Prevention of further urinary tract infections
• Reduced risk of kidney damage
• Minimal recovery time compared to open surgery

Recovery

• Most patients can go home the same day or the following day.
• Drink plenty of water to help flush out stone fragments.
• Avoid heavy lifting or strenuous activity for a few days.
• Pain and discomfort medication may be prescribed.
• Follow-up appointments to assess the removal of stones and recovery progress.

Alternatives

• Extracorporeal shock wave lithotripsy (ESWL)
• Percutaneous nephrolithotomy (PCNL)
• Open surgery for very large or complicated stones
• Conservative management with pain management and hydration for small stones

Patient Experience

The patient will be under anesthesia and should not feel pain during the procedure. Post-procedure, there may be mild discomfort, a burning sensation during urination, and possibly blood in the urine for a few days. Pain management and hydration are important for a smooth recovery.