Name of the Procedure:

Cystourethroscopy (including ureteral catheterization) with Subureteric Injection of Implant Material

Summary

Cystourethroscopy with subureteric injection of implant material is a minimally invasive procedure where a doctor examines the inside of the bladder and urethra using a cystoscope and then injects a material near the ureters to prevent urine reflux.

Purpose

The procedure is primarily used to treat vesicoureteral reflux (VUR), a condition where urine flows backward from the bladder into the ureters and kidneys. The goal is to stop this reflux, thereby preventing kidney damage and recurrent urinary tract infections.

Indications

• Signs of vesicoureteral reflux (VUR)
• Recurrent urinary tract infections
• Kidney damage or scarring due to urine reflux
• Failure of conservative treatments (e.g., antibiotics)
• Grading of VUR that necessitates intervention

Preparation

• Patients may need to fast for a few hours before the procedure.
• A pre-procedure urine test is often required to ensure there is no active infection.
• The healthcare provider may adjust certain medications.
• Patients need to arrange for transportation home due to the use of anesthesia.

Procedure Description

1. The patient is positioned on the examination table.
2. Anesthesia, typically local with sedation or general, is administered.
3. A cystoscope, which is a flexible tube with a camera, is inserted through the urethra into the bladder.
4. The bladder is examined for any abnormalities.
5. A small catheter may be placed into the ureters.
6. A biocompatible material is injected near the ureter openings (subureteric region) to create a bulge, preventing urine from flowing back into the ureters.
7. The cystoscope and catheter are removed, and the procedure is completed.

Duration

The procedure typically takes about 30-60 minutes.

Setting

It is performed in a hospital, outpatient clinic, or specialized surgical center.

Personnel

• Urologist or pediatric urologist
• Nurses
• Anesthesiologist

Risks and Complications

• Temporary bleeding or discomfort in the bladder
• Risk of infection
• Allergic reaction to the implant material
• Blockage of the ureter
• Need for repeat procedures if the reflux persists

Benefits

• Reduction or elimination of vesicoureteral reflux
• Decreased risk of future urinary tract infections
• Prevention of kidney damage
• Improvement typically seen within weeks

Recovery

• Patients can usually go home the same day.
• Mild discomfort and a moderate need to urinate frequently for a few days.
• Follow-up appointment to assess the effectiveness of the treatment.
• Avoid heavy lifting and strenuous activities for a few days.
• Increase fluid intake to help flush the bladder.

Alternatives

• Long-term antibiotic therapy to prevent infections
• Open or laparoscopic surgery to correct the reflux
• The choice of alternative treatments depends on the severity of the condition and patient-specific factors.

Patient Experience

• During the procedure, the patient may be under sedation or anesthesia, ensuring minimal discomfort.
• Post-procedure, they may feel mild discomfort or a burning sensation during urination.
• Pain management will include over-the-counter pain relievers if needed.
• Patients are generally able to resume normal activities within a few days with some restrictions based on the healthcare provider's recommendations.