Name of the Procedure:

Catheter, Ureteral (C1758)

Common Names:

• Ureteral catheterization
• Ureteral stenting

Medical Terms:

• Ureteral catheter insertion
• Placement of ureteral catheter

Summary

Ureteral catheterization involves placing a flexible tube (catheter) into the ureter (the duct that urine passes through from the kidney to the bladder) to help with urine drainage. This procedure is commonly done to relieve obstructions or to ensure proper urine flow post-surgery.

Purpose

The procedure addresses issues such as:

• Blockages in the ureter due to kidney stones, tumors, or strictures.
• Assisting urine flow after urinary tract surgeries.
• Facilitating the administration of contrast dye during diagnostic imaging.

Goals:

• Alleviate pain and discomfort caused by urinary obstructions.
• Prevent kidney damage by ensuring proper urine drainage.
• Assist in diagnostic procedures for better visualization of the urinary tract.

Indications

Symptoms/Conditions:

• Severe back or abdominal pain indicative of kidney stone obstruction.
• Blood in the urine (hematuria) due to tumors or strictures.
• Inability to urinate due to blockages.

Patient Criteria:

• Patients with diagnosed ureteral blockages.
• Patients undergoing surgery that could impact urine flow.
• Individuals requiring detailed urinary tract imaging.

Preparation

Instructions:

• Fasting for a specified period before the procedure if sedation or anesthesia is planned.
• Adjustments in certain medications as advised by the healthcare provider.
• Pre-procedure blood and urine tests to check for infections and kidney function.

Diagnostic Tests:

• Imaging studies such as ultrasound, CT scan, or X-rays (including KUB - Kidney, Ureter, and Bladder).

Procedure Description

Step-by-Step Explanation:

1. The patient is positioned on the procedure table.
2. If needed, sedation or local/general anesthesia is administered.
3. A cystoscope (a thin, tube-like instrument with a camera) is inserted through the urethra into the bladder.
4. Under visual guidance, a catheter is navigated through the bladder and into the affected ureter.
5. The catheter is positioned to bypass the obstruction or assist in urine drainage.
6. The cystoscope is carefully withdrawn, leaving the catheter in place.

Equipment Used:

• Cystoscope
• Ureteral catheter
• Guidewire (if needed)

Anesthesia:

• Local, regional, or general anesthesia depending on patient and procedure specifics.

Duration

The procedure typically takes about 30-60 minutes, depending on complexity and patient-specific factors.

Setting

Ureteral catheterization is commonly performed in:

• Hospital operating rooms
• Outpatient surgical centers
• Specialized urology clinics

Personnel

• Urologist or surgeon
• Surgical nurses
• Anesthesiologist or nurse anesthetist (if anesthesia is used)

Risks and Complications

Common Risks:

• Mild discomfort or pain during and after the procedure
• Urinary tract infection (UTI)
• Blood in the urine (hematuria)

Rare Complications:

• Perforation of the ureter
• Migration or blockage of the catheter
• Severe infection or sepsis
• Reaction to anesthesia

Benefits

Expected Benefits:

• Immediate relief from pain caused by ureteral obstruction
• Prevention of kidney damage
• Improved diagnostic imaging quality

Timeframe:

• Benefits are often realized immediately or within a few days post-procedure.

Recovery

Care and Instructions:

• Drink plenty of fluids to flush the urinary system.
• Antibiotics if prescribed to prevent infection.
• Pain management with over-the-counter or prescribed medications.
• Follow-up appointments for catheter assessment or removal.

Recovery Time:

• Most patients return to normal activities within a few days.
• Restrictions may include avoiding heavy lifting and strenuous activities for a short period.

Alternatives

Other Options:

• Extracorporeal Shock Wave Lithotripsy (ESWL) for kidney stone removal.
• Percutaneous nephrostomy for direct kidney drainage.
• Medications to dissolve or pass small stones.

Pros and Cons:

• ESWL is non-invasive but may not be effective for all stone sizes/types.
• Percutaneous nephrostomy is highly effective but more invasive than ureteral catheterization.
• Medications are less invasive but may take longer to relieve symptoms.

Patient Experience

During the Procedure:

• Feeling of pressure or discomfort as the cystoscope is inserted.
• Sedation or anesthesia will minimize pain and discomfort.

After the Procedure:

• Possible mild discomfort in the urethral area and lower abdomen.
• Blood-tinged urine and frequency may occur temporarily.
• Pain management strategies to ensure comfort, such as oral pain relievers or mild over-the-counter medications.

By following the healthcare provider's instructions and attending follow-up appointments, most patients experience a smooth and swift recovery.