Name of the Procedure:

Cystourethroscopy with Ureteroscopy; Treatment of Intra-Renal Stricture (e.g., Balloon Dilation, Laser, Electrocautery, Incision)

Summary

Cystourethroscopy with ureteroscopy is a medical procedure used to examine and treat strictures (narrowing) inside the kidneys. The procedure involves using small instruments to view the urinary tract and correct the stricture using techniques like balloon dilation, laser, electrocautery, or incision.

Purpose

This procedure addresses intra-renal strictures that can obstruct urine flow, leading to kidney problems or pain. The goal is to clear the obstruction and restore normal urine flow, helping to preserve kidney function and alleviate symptoms.

Indications

• Persistent pain in the kidney area
• Recurrent urinary tract infections (UTIs)
• Decreased kidney function due to obstruction
• Difficulty in passing urine
• Hematuria (blood in urine)

Preparation

• Patients may need to fast for several hours before the procedure.
• Medication adjustments, particularly blood thinners, may be necessary.
• Pre-procedure imaging tests like ultrasound or CT scans to assess the stricture.

Procedure Description

1. Patient is positioned and given anesthesia (general or local with sedation).
2. A cystoscope is inserted through the urethra to the bladder.
3. A ureteroscope is then used to navigate up to the kidney.
4. Visualization of the stricture is achieved using the scope’s camera.
5. The stricture is treated using one of the following techniques:
   • Balloon dilation: A balloon is inflated to widen the narrowed area.
   • Laser: Laser energy is used to cut through or evaporate the stricture.
   • Electrocautery: Electric current is used to cut or coagulate tissue.
   • Incision: Precision instruments are used to make small cuts to open the stricture.
6. Instruments are removed, and the patient is monitored as the anesthesia wears off.

Duration

The procedure typically takes around 1 to 2 hours, depending on complexity.

Setting

Typically performed in a hospital or an outpatient surgical center.

Personnel

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

Risks and Complications

• Infection
• Bleeding
• Injury to the urinary tract
• Stricture recurrence
• Adverse reaction to anesthesia
• Urinary retention

Benefits

• Relief from symptoms such as pain and difficulty urinating
• Improved kidney function
• Reduced risk of recurrent infections
• Typically, benefits are felt soon after recovery from the procedure.

Recovery

• Patients may need to stay for observation for a few hours.
• Pain management through prescribed medications.
• Drinking plenty of fluids to flush out the urinary system.
• Avoiding strenuous activities for a few days.
• Follow-up appointment within a few weeks to check on recovery.

Alternatives

• Medication to manage symptoms (less effective in the long term)
• Open surgery (more invasive, longer recovery)
• Observation if the stricture is mild and asymptomatic

Patient Experience

• During the procedure: Patients under general anesthesia will not feel anything; those with local anesthesia may feel minimal discomfort.
• After the procedure: Some pain or discomfort during urination, managed with pain relief medications. Temporary urinary catheter might be placed to assist with urination.
• Mild bleeding or spotting may occur but should resolve shortly.