52342 Cystourethroscopy; with treatment of ureteropelvic junction stricture (eg, balloon dilation, laser, electrocautery, and incision)

Name of the Procedure:

Cystourethroscopy with treatment of ureteropelvic junction stricture
(Common names: Cystoscopy with UPJ stricture dilation, Laser UPJ stricture treatment, Electrocautery UPJ incision)

Summary

Cystourethroscopy with treatment of a ureteropelvic junction (UPJ) stricture is a minimally invasive procedure in which a scope is used to view the urethra and bladder and treat a blockage at the junction where the ureter meets the renal pelvis. This is often accomplished through techniques such as balloon dilation, laser ablation, electrocautery, or incision to widen the narrowed area, allowing for normal urine flow from the kidney to the bladder.

Purpose

This procedure addresses blockages or strictures at the ureteropelvic junction that hinder proper urine flow from the kidneys to the bladder. The primary goal is to alleviate the obstruction, prevent kidney damage, reduce symptoms like pain and infections, and restore normal urinary function.

Indications

• Symptoms such as flank pain, recurrent kidney infections, or hematuria (blood in the urine).
• Diagnosed UPJ obstruction through imaging studies like ultrasound, CT scan, or MR urography.
• Decreased kidney function due to the blockage.
• Failure of conservative treatments to relieve symptoms or improve condition.

Preparation

• Patients may be instructed to fast for several hours prior to the procedure.
• Pre-procedure evaluations might include blood tests, urine analysis, imaging studies, and a thorough medical history review.
• Patients should discuss any current medications with their doctor, as adjustments may be necessary, especially with blood thinners.

Procedure Description

1. The patient is generally placed under regional or general anesthesia.
2. A cystoscope (a thin, flexible tube with a camera) is inserted through the urethra into the bladder.
3. Once the bladder is assessed, the scope is guided towards the ureteropelvic junction.
4. Depending on the chosen method—balloon dilation, laser ablation, electrocautery, or a surgical incision—is performed to treat the stricture.
5. In balloon dilation, a small balloon is inserted and then expanded to widen the narrowed area.
6. In laser or electrocautery, energy is used to carefully remove or remodel the tissue obstructing the junction.
7. In cases requiring an incision, a small cut is made to enlarge the junction.
8. A stent might be placed to keep the ureter open as it heals.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is usually performed in a hospital or an outpatient surgical center with appropriate facilities.

Personnel

• Urologist or specialized surgeon
• Surgical nurses
• Anesthesiologist
• Support staff for postoperative care

Risks and Complications

• Common risks: bleeding, infection, and pain at the procedure site.
• Rare risks: injury to surrounding tissues, scar tissue formation, and potential for recurrence of stricture.
• Complications are managed with medication, additional procedures, or supportive care as needed.

Benefits

• Relief from symptoms such as pain and recurrent infections.
• Prevention of further kidney damage.
• Improved quality of life with restored normal urinary function.
• Benefits are typically realized shortly after recovery from the procedure.

Recovery

• Post-procedure care may include pain management, antibiotics to prevent infection, and instructions for stent care if placed.
• Patients may experience mild discomfort or blood-tinged urine initially.
• Most patients can resume normal activities within a few days, but heavy lifting and strenuous activities should be avoided for several weeks.
• Follow-up appointments are necessary to monitor healing and stent removal if applicable.

Alternatives

• Conservative treatments such as medication, observation, and lifestyle changes.
• Open or laparoscopic surgery to correct the UPJ obstruction.
• Endopyelotomy (internal incision with a scope).
• Pros and cons of alternatives include varying recovery times, risk profiles, and effectiveness.

Patient Experience

During the procedure, patients will be under anesthesia and should not feel pain. After waking up, patients may feel some discomfort, which can be managed with prescribed pain medications. Mild cramping or a burning sensation while urinating is normal. Staying hydrated and following postoperative instructions will aid in a smoother recovery.