Name of the Procedure:

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

Summary

Cystourethroscopy with ureteroscopy is a minimally invasive procedure where doctors use a scope to examine the urinary tract, including the bladder, urethra, and ureters. The procedure is aimed at treating a stricture, or narrowing, at the ureteropelvic junction (UPJ)—the area where the ureter meets the kidney. Treatments may include balloon dilation, laser therapy, electrocautery, or surgical incision to open up the narrowed area.

Purpose

Cystourethroscopy with ureteroscopy addresses UPJ strictures, which can cause impaired urine flow from the kidney to the bladder, leading to pain, infections, and possible kidney damage. The goal is to relieve the blockage and restore normal urine flow, reducing symptoms and preventing complications.

Indications

• Persistent flank pain or discomfort
• Recurrent urinary tract infections (UTIs)
• Hydronephrosis (swelling of a kidney due to urine buildup)
• Decreased kidney function due to the obstruction

Preparation

• Fasting for at least 6-8 hours prior to the procedure
• Adjusting or temporarily stopping certain medications (e.g., blood thinners)
• Undergoing pre-procedure assessments, such as blood tests, urine tests, and imaging studies (e.g., ultrasound, CT scan)

Procedure Description

1. The patient is given anesthesia to ensure comfort.
2. A cystoscope is inserted through the urethra to view the bladder.
3. A ureteroscope is advanced through the bladder into the ureter and up to the ureteropelvic junction.
4. The stricture is observed, and treatment is performed:
   • Balloon dilation to widen the narrowed area
   • Laser to remove or vaporize scar tissue
   • Electrocautery to burn and remove the stricture
   • Incision to surgically cut and open the narrowed segment
5. Any debris from the procedure is removed, and the area is cleaned.
6. Stents may be placed to keep the ureter open during healing.

Duration

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

Setting

This procedure is usually performed in a hospital or specialized surgical center with the necessary equipment and support staff.

Personnel

• Urologist or specialized surgeon
• Anesthesiologist
• Supporting nurses and surgical technicians

Risks and Complications

• Infection
• Bleeding
• Injury to the ureter or surrounding organs
• Postoperative pain or discomfort
• Risk of stricture recurrence
• Potential need for additional procedures

Benefits

• Relief from pain and symptoms associated with UPJ stricture
• Restored urine flow from the kidney to the bladder
• Prevention of kidney damage and further complications
• Short recovery time compared to open surgery

Recovery

• Post-procedure monitoring in a recovery area
• Prescription of pain medications and antibiotics, if needed
• Instructions on caring for a stent, if placed
• Avoidance of strenuous activities for at least a week
• Follow-up appointments to monitor healing and effectiveness

Alternatives

• Observation and monitoring if symptoms are mild
• Open surgical repair, which involves a larger incision and longer recovery
• Laparoscopic surgery with smaller incisions but more complex than endoscopic methods

Patient Experience

Patients may feel some pressure or discomfort during the procedure if not fully sedated. Post-procedure, some pain and discomfort in the lower abdomen and urinary frequency or urgency can be expected. Pain management strategies and sufficient hydration are emphasized for a smoother recovery.

By following these detailed guidelines, patients can better understand what to expect from a cystourethroscopy with ureteroscopy for the treatment of a UPJ stricture.