Name of the Procedure:

Cystourethroscopy with Ureteroscopy and/or Pyeloscopy; with Resection of Ureteral or Renal Pelvic Tumor

Summary

Cystourethroscopy, with ureteroscopy and/or pyeloscopy, with resection of ureteral or renal pelvic tumor, is a minimally invasive procedure used to visualize and treat tumors in the ureter or renal pelvis. It involves using a special camera to look inside the bladder, ureters, and kidneys, and surgical instruments to remove the tumor.

Purpose

This procedure addresses the presence of tumors in the ureter or renal pelvis. The primary goal is to remove the tumor, alleviate symptoms, and prevent the spread of cancer.

Indications

• Hematuria (blood in the urine)
• Flank pain
• Recurrent urinary tract infections
• Ureteral/renal pelvic tumors identified on imaging studies
• Obstruction of the ureter or kidney

Preparation

• Fasting for at least 8 hours before the procedure
• Adjusting or temporarily stopping certain medications, as instructed by the doctor
• Undergoing preoperative diagnostic tests, such as blood work, urine tests, and imaging studies

Procedure Description

1. The patient is given anesthesia, usually general anesthesia.
2. A cystoscope (a thin tube with a camera) is inserted through the urethra to visualize the bladder and ureters.
3. A ureteroscope may then be passed through the cystoscope to access the ureter and renal pelvis.
4. For pyeloscopy, a flexible scope is used to inspect the kidney's renal pelvis.
5. Specialized instruments are introduced through these scopes to resect (cut out) the tumor.
6. The removed tumor is sent for pathological examination.
7. The area is inspected to ensure complete removal and hemostasis (stoppage of bleeding).
8. The instruments are withdrawn, and the patient is monitored in recovery.

Duration

The procedure typically takes 1 to 3 hours, depending on the tumor's size and location.

Setting

The procedure is performed in a hospital operating room or an outpatient surgical center.

Personnel

• Urologist or specialized surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Common risks: Infection, bleeding, urinary tract infection, and discomfort.
• Rare complications: Ureteral perforation, stricture formation, damage to surrounding organs, or anesthesia-related issues.

Benefits

• Effective removal of the tumor
• Relief from symptoms like pain and bleeding
• Prevention of tumor spread or recurrence
• Improved urinary tract function

Recovery

• Immediate watch in a recovery room for a short period
• Pain management with prescribed medications
• Hydration and avoidance of strenuous activities
• Expect some blood in the urine and mild discomfort for a few days
• Follow-up appointments for further assessment and to review pathology results
• Possible temporary use of a ureteral stent to facilitate healing

Alternatives

• Open or laparoscopic surgery to remove the tumor
• Percutaneous nephrolithotomy
• Systemic therapies or chemotherapy for extensive disease
• Each alternative has its own pros and cons relating to invasiveness, recovery time, and possible efficacy.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Post-procedure, discomfort, and mild bleeding in the urine are common but manageable with medications. The healthcare team will provide detailed care instructions and ensure the patient's comfort and recovery.