Name of the Procedure:

Cystourethroscopy with Ureteroscopy; Treatment of Ureteral Stricture (e.g., Balloon Dilation, Laser, Electrocautery, and Incision)

Summary

Cystourethroscopy with ureteroscopy is a medical procedure where a doctor examines the inside of the bladder, urethra, and ureter using a scope. The procedure can include treatments such as balloon dilation, laser, electrocautery, and incision to address a narrowing or stricture in the ureter.

Purpose

This procedure aims to diagnose and treat ureteral strictures, which are narrowings in the ureter that can obstruct the flow of urine from the kidney to the bladder. The goals are to relieve symptoms, improve urinary flow, and prevent complications like kidney damage.

Indications

• Difficulty urinating
• Pain in the side (flank pain)
• Recurrent urinary tract infections
• Decreased kidney function due to obstruction
• Previous imaging studies showing a narrowing in the ureter

Preparation

• Fasting for several hours prior to the procedure, typically starting from midnight the night before.
• Adjustments or cessation of certain medications as advised by the physician.
• Pre-procedure imaging tests like ultrasound or CT scan to pinpoint the location and severity of the stricture.

Procedure Description

1. The patient is given anesthesia or sedation to ensure comfort.
2. A cystoscope is inserted through the urethra to examine the bladder.
3. A ureteroscope is then advanced into the ureter.
4. Various treatments may be applied depending on the nature of the stricture:
   • Balloon Dilation: A small balloon is inflated to widen the narrowed area.
   • Laser or Electrocautery: Used to remove or cut away the scar tissue causing the stricture.
   • Incision: Small cuts are made to open up the narrowed section.
5. The instruments are then removed, and any immediate post-procedure checks are performed.

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity of the stricture treatment.

Setting

This procedure is usually performed in a hospital, outpatient surgical center, or specialized urology clinic.

Personnel

• Urologist (surgeon)
• Anesthesiologist or nurse anesthetist
• Surgical nurses and technicians

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding tissues or organs
• Stricture recurrence
• Reaction to anesthesia
• Temporary difficulty urinating

Benefits

• Relief from symptoms associated with ureteral stricture
• Improved urine flow and kidney function
• Reduced risk of recurrent urinary tract infections
• Prevention of long-term kidney damage

Recovery

• Post-procedure, you may need to stay in the recovery area for a few hours.
• Instructions typically include drinking plenty of fluids, avoiding strenuous activities for a few days, and monitoring for signs of infection.
• Pain management may involve over-the-counter pain relievers or prescribed medications.
• Follow-up appointments may include imaging studies to ensure the stricture has been fully resolved.

Alternatives

• Conservative management with observation and medications
• Endoscopic stent placement
• Open surgical repair
• Pros of the described procedure include minimally invasive nature and quick recovery. Cons might include the potential need for repeat procedures if the stricture recurs.

Patient Experience

• During the procedure, you’ll be under anesthesia or sedation and should not feel pain.
• Post-procedure, you may experience mild discomfort or a burning sensation when urinating, which usually subsides within a few days.
• Pain management and monitoring for any signs of complications are key to ensuring a smooth recovery.