Name of the Procedure:

Cystourethroscopy, with Ureteroscopy and/or Pyeloscopy; with Removal or Manipulation of Calculus (Ureteral Catheterization Included)

Summary

This procedure involves using a specialized scope to examine and treat the urinary tract, including the bladder, urethra, ureters, and kidneys. It includes the removal or adjustment of kidney stones (calculus) using a ureteral catheter if necessary.

Purpose

This procedure is primarily done to diagnose and treat kidney stones and other abnormalities within the urinary tract. The goals are to alleviate pain, prevent urinary tract obstruction, and reduce the risk of infection or kidney damage.

Indications

• Persistent or severe abdominal pain due to kidney stones
• Blood in the urine (hematuria)
• Recurrent urinary tract infections (UTIs)
• Difficulty urinating or frequent urination
• Abnormal imaging results indicating blockages or stones in the urinary tract

Preparation

• Fasting for a specified period (usually 6-8 hours) before the procedure.
• Adjustments in medications, particularly blood thinners, as advised by the healthcare provider.
• Pre-procedure diagnostic tests such as blood tests, urine tests, or imaging studies (CT scan, ultrasound).

Procedure Description

1. Anesthesia: The procedure typically requires general or spinal anesthesia.
2. Insertion of the Scopes: The cystoscope is inserted through the urethra to visualize the bladder and ureters.
3. Inspection and Diagnosis: The ureteroscopy provides a detailed view of the ureters and kidneys.
4. Stone Removal: If stones are found, specialized instruments are used to either remove or break them into smaller pieces (lithotripsy).
5. Catheterization: A ureteral catheter might be placed to ensure urine drainage and promote healing.

Tools used include cystoscopes, ureteroscopes, laser fibers, retrieval baskets, and catheters.

Duration

The procedure usually takes 30 minutes to an hour, but complex cases may take longer.

Setting

Typically performed in a hospital or surgical center.

Personnel

• Urologist (surgeon)
• Anesthesiologist
• Surgical nurses
• Technicians for equipment handling

Risks and Complications

• Common: Pain, burning sensation while urinating, blood in the urine, urinary tract infection
• Rare: Injury to the urinary tract, stricture formation, severe bleeding, adverse reactions to anesthesia

Benefits

• Relief from pain and discomfort caused by kidney stones.
• Prevention of complications such as kidney damage or persistent infections.
• Improvement in urinary function.

Recovery

• Patients may need to stay in the hospital for a few hours post-procedure for monitoring.
• Instructions may include increased fluid intake, pain management guidelines, avoiding strenuous activities, and taking prescribed antibiotics.
• Full recovery typically takes a few days to a week, and follow-up appointments may be scheduled to ensure proper healing.

Alternatives

• Extracorporeal Shock Wave Lithotripsy (ESWL): Uses shock waves to break stones into smaller pieces.
• Medical therapy: Medications to dissolve certain types of stones and promote their natural passage.
• Percutaneous Nephrolithotomy: Surgical removal of very large stones through a small incision in the back.

Each alternative has its pros and cons, depending on the size, location, and type of stone, as well as the patient's overall health.

Patient Experience

During the procedure, due to anesthesia, the patient will not feel pain. Post-procedure, some discomfort, burning with urination, and blood in the urine can be expected. Pain management will be provided through medications, and most patients see improvement in symptoms within a few days, with the full benefits realized as the urinary tract heals.