pyeloscopy

What is involved in the pyeloscopy procedure?

Pyeloscopy, a minimally invasive medical procedure, involves using a thin, flexible tube called a pyeloscope to examine and treat conditions within the urinary tract, specifically the kidney. This versatile technique is commonly employed for diagnosing and addressing issues such as kidney stones, and tumours. Pyeloscopy offers the advantage of direct visualization, allowing urologists to navigate the intricate structures of the urinary system with precision. Indicated in various cases, it is particularly useful for treating larger stones or those located in challenging anatomical positions.

Indications for Pyeloscopy: Pyeloscopy is indicated in situations where kidney stones or other urinary tract abnormalities require intervention. It is particularly recommended for larger stones that may not be effectively treated with conservative measures alone. Additionally, it is employed to investigate and address conditions such as tumours growing within the linings of the kidneys.

Ureteric Stent: A ureteric stent may be utilized in certain pyeloscopy procedures. This small, flexible tube is placed into the ureter to allow urine to flow freely from the kidney to the bladder and alleviate any potential blockages. Ureteric stents are often employed to facilitate the passage of stone fragments after pyeloscopy and can be left in place temporarily to aid in the healing process. While providing essential relief, the presence of a ureteric stent can also cause some discomfort, and its duration of use is determined by the specific needs of the patient and the nature of the underlying condition.

Pyeloscopy main points

Key Points:

• The procedure aims to fragment stones in the kidney using a thin telescope passed through the urethra.

• Laser energy, transmitted through a small laser fiber, is commonly employed to break up stones.

• Pyeloscopy has significantly reduced the necessity for open surgery in stone removal.

• Pyeloscopy has an instrumental role in assessing lesions within the lining of the kidneys.

surgery

What occurs on the day of the procedure?

A/Prof Homi Zargar will discuss the surgery once again to ensure your understanding and obtain your consent. An anaesthetist will meet with you to explore the options of a general or spinal anaesthetic and discuss post-procedure pain relief.

Details of the procedure:

• Antibiotics are given after allergy checks for infection prevention.

• A telescope is inserted through the urethra into the bladder.

• A guidewire is advanced into the kidney under X-ray control.

• The telescope is guided to the stone using the guidewire.

• Stone fragmentation is done using laser.

• Laser may "dust" the stone or break it into fragments.

• For renal lining lesions a biopsy may be taken.

• A temporary drainage tube (stent) may be inserted into the ureter.

• A "second-look" pyeloscopy may be performed if needed.

• Some patients may go home on the same day.

After-Effects and Risks of the Procedure:

• Mild burning or bleeding during urination may occur briefly following the procedure, particularly if a ureteric stent is present (Almost all patients).

• Temporary placement of a ureteric stent is part of the procedure, and it will require removal at a later time (Almost all patients).

• Recurrent (new) stone formation within the next five to 10 years, necessitating additional surgery or alternative treatments (1 in 20 patients).

• Residual stones that may require further surgery or other interventions, with a higher likelihood for stones situated closer to the kidney (Between 1 in 7 & 1 in 20 patients).

• Difficulty accessing the ureter or reaching the stone, leading to the need for additional surgery or alternative treatments (1 in 20 patients)..

• Temporary insertion of a bladder catheter as part of the procedure (Between 1 in 10 & 1 in 50 patients).

• Infection arising, requiring antibiotic treatment (Between 1 in 10 & 1 in 50 patients).

• Minor damage to the ureter wall, such as small perforations, mucosal abrasion, or bleeding, may necessitate stenting or percutaneous nephrostomy (1 in 100 patients).

• Ureter narrowing due to delayed scar formation (stricture), potentially requiring further treatment (Between 1 in 100 & 1 in 250 patients).

• Major damage to the ureter wall, including large perforations or avulsion, may necessitate additional surgery (Less than 1 in 1000 patients).

• Possible anesthetic or cardiovascular complications that may necessitate intensive care, encompassing issues like chest infection, pulmonary embolism, stroke, deep vein thrombosis, heart attack, and potential fatalities(Between 1 in 50 & 1 in 250 patients).