Name of the Procedure:

Cystourethroscopy, with insertion of indwelling ureteral stent (e.g., Gibbons or double-J type)

Summary

Cystourethroscopy with the insertion of an indwelling ureteral stent is a medical procedure where a flexible tube (stent) is placed into the ureter through an endoscopic device. This stent helps keep the ureter open and ensures proper urine flow from the kidneys to the bladder.

Purpose

The procedure addresses obstructions in the ureter, which can be caused by kidney stones, tumors, or narrowing of the ureteral passage. The goal is to relieve urinary blockage, prevent kidney damage, and ensure the proper drainage of urine.

Indications

• Severe kidney stones blocking the ureter.
• Tumors causing ureteral obstruction.
• Strictures or narrowing of the ureter.
• Post-surgical swelling of the urinary tract.
• To ensure urine flow after certain surgical procedures on the ureter or surrounding areas.

Preparation

• The patient may be instructed to fast for several hours before the procedure.
• Patients might need to stop certain medications, such as blood thinners, before the procedure.
• Preoperative diagnostic tests may include urine tests, blood work, and imaging studies like an ultrasound or CT scan.

Procedure Description

1. The patient is given either general or local anesthesia.
2. A cystoscope, a thin tube with a camera, is gently inserted through the urethra into the bladder.
3. Using the cystoscope, the surgeon visualizes the bladder and ureteral openings.
4. A guidewire is then inserted through the cystoscope into the ureter.
5. The stent (Gibbons or double-J type) is passed over the guidewire and positioned within the ureter.
6. Once the stent is in place, the cystoscope is carefully removed.
7. The placement is confirmed using x-ray or another imaging technique.

Tools and Equipment:

• Cystoscope
• Guidewire
• Indwelling ureteral stent (e.g., Gibbons or double-J type)
• Imaging tools for confirmation

Anesthesia:

• General or local anesthesia, depending on the patient's condition and the complexity of the procedure.

Duration

The procedure typically takes 30 minutes to an hour.

Setting

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

Personnel

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

Risks and Complications

• Infection
• Bleeding
• Pain or discomfort
• Stent migration or dislodgement
• Ureteral injury or perforation
• Bladder spasms

Complications are generally manageable with appropriate medical care.

Benefits

• Relief from urinary obstruction.
• Prevention of kidney damage.
• Improved kidney function and symptom relief can be expected shortly after the procedure.

Recovery

• Patients may experience some discomfort or blood in the urine for a few days.
• Pain management may include prescribed pain relievers.
• Limited physical activity is recommended for a few days.
• Follow-up appointments are essential to monitor stent position and function.

Alternatives

• Extracorporeal shock wave lithotripsy (ESWL) for kidney stones.
• Percutaneous nephrostomy.
• Open or laparoscopic surgery for severe obstructions.

Each alternative has specific pros and cons; for instance, ESWL is non-invasive but may not be suitable for large or hard stones.

Patient Experience

During the procedure, patients will be under anesthesia, so they won't feel any pain. Post-procedure, there might be some discomfort, mild cramping, or spotting of blood in the urine. Pain management strategies and detailed care instructions will be provided to ensure comfort and aid recovery.