Name of the Procedure:

Cystourethroscopy with Insertion of Ureteral Guide Wire Through Kidney to Establish a Percutaneous Nephrostomy, Retrograde

Summary:

This procedure involves using a special camera (cystoscope) to look inside the bladder and urethra. A guide wire is then inserted through the urinary system up to the kidney. This wire helps establish a nephrostomy, a small tube that drains urine from the kidney to an external bag.

Purpose:

This procedure is performed to drain urine directly from the kidney when there is a blockage that prevents normal urination. It helps relieve pressure and prevent damage to the kidneys.

Indications:

• Severe urinary tract obstruction
• Kidney stones blocking urine flow
• Hydronephrosis (swelling of the kidney due to urine build-up)
• Certain cancers blocking the urinary tract
• Failure of other less invasive treatments

Preparation:

• Fasting for at least 6 hours before the procedure
• Adjustment or discontinuation of certain medications such as blood thinners
• Pre-procedure imaging tests like an ultrasound or CT scan
• Blood tests to check kidney function and blood clotting levels

Procedure Description:

1. Anesthesia: General or regional anesthesia to ensure the patient is comfortable and pain-free.
2. Cystourethroscopy: A cystoscope is inserted through the urethra into the bladder.
3. Guide Wire Insertion: The guide wire is passed through the urinary system up to the kidney.
4. Nephrostomy Establishment: Using the guide wire, a nephrostomy catheter is placed in the kidney to facilitate urine drainage.
5. Imaging Guidance: Fluoroscopy or ultrasound may be used for precise placement.
6. Final Checks: Confirmation of catheter placement and functionality.

Duration:

The procedure typically takes about 1 to 2 hours.

Setting:

This procedure is generally performed in a hospital operating room or a specialized outpatient surgical center.

Personnel:

• Urologist or interventional radiologist (lead surgeon)
• Surgical nurses
• Anesthesiologist
• Radiologic technologist

Risks and Complications:

• Infection
• Bleeding
• Injury to surrounding organs
• Displacement or blockage of the nephrostomy tube
• Rarely, reactions to anesthesia

Benefits:

• Immediate relief from kidney pain due to obstruction
• Prevention of further kidney damage
• Improved kidney function
• Reduction of infection risk

Recovery:

• Post-procedure observation in recovery room
• Hospital stay of 1-2 days may be required
• Pain management with prescribed medications
• Instructions for nephrostomy tube care
• Follow-up appointments to monitor kidney function and tube placement

Alternatives:

• Ureteral stent placement: A tube inside the ureter to keep it open
• Extracorporeal shock wave lithotripsy (ESWL): Non-invasive treatment for kidney stones
• Open or laparoscopic surgery to remove the obstruction
  • Pros and Cons: Less invasive options may have shorter recovery times but may not be as effective in severe cases. Surgery offers a more permanent solution but with longer recovery.

Patient Experience:

• Patients may feel groggy post-anesthesia
• Mild discomfort at the nephrostomy tube site
• Managing the nephrostomy bag can take some adjustment but usually becomes routine
• Pain management and antibiotics to prevent infection will be provided
• Gradual return to normal activities as healing progresses

This procedure aims to relieve kidney obstruction effectively, enhancing patient comfort and kidney health.