Ureteroscopy and Fulguration Lesion

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Why is it done?

  • Viewing suspicious lesions in upper urinary tracts (ureter and renal pelvis)
  • Flexible uretero-renoscopy to review inside of the renal pelvis and renal calyces
  • Removal of the lesion using laser
  • Rigid is better for the ureteric inspection

 

How is it done?

  • Patients will receive general anaesthesia.
  • Prophylactic antibiotics are given.
  • The correct kidney is identified and marked while you are awake
  • You would have had a cystoscopy with retrograde pyelogram 10 days prior with the placement of a ureteric stent to prepare your ureter
  • A cystoscopy will be done first to remove the stent, and 2 guidewires will be placed to enable access up the ureter
  • Depending on the position of the lesion, either a rigid or flexible uretero-renoscope will be used.
  • Suspicious lesions may be biopsied and fulgurated.
  • Laser fulguration or Diathermy may be used.
  • Catheters will be removed the next morning depending on the presence of blood in the urine
  • Extended use of a ureteric stent may be advised, depending on the degree of bleeding

 

Complications

  • Ureteric perforation
  • Stricturing / Narrowing
  • Disruption of ureter
  • Stent Irritation
  • Procedure abandoned due to bleeding

 

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Wes Ureteroscopy and Fulgeration lesion

Copyright 2019 Dr Jo Schoeman

Ureterotomy

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What is it?

  • Opening up of a very narrowed/ obstructed ureteric opening. Either by cold knife or laser.
  • Where a congenital / acquired narrowing in the ureteric opening occurs.
  • This procedure is used to open the ureter and ease the urine flow. It can cause Vescio ureteric reflux.

Why is it done?

  • Congenital narrowing of the ureteric opening in the bladder as per a Ureterocele.
  • Previous bladder surgery where the ureteric orifice was involved: i.e. Bladder tumour resection.
  • Where conservative measures have failed: i.e. Stenting, Dilatation etc.
  • To prevent renal function deterioration.
  • Stenting or nephrostomy placement would have been done in the acute state to relief an obstructed and infected system.

How is it done?

  • Patients will receive a general anesthesia.
  • Prophylactic antibiotics is given.
  • The correct kidney is identified and marked while you are awake.
  • This will be an endoscopic procedure.
  • A cystoscopy will be done with placement of ureteric guidewire.
  • Laser will be used to cut the stricture open.
  • The alternative is using endoscopic scissors (when available).
  • A ureteric stent is left with an Indwelling Urethral catheter.
  • A ureteric stent is placed for 6 weeks and an indwelling catheter overnight.

What next?

  • You may be in hospital for 1-2 days.
  • You may have continuous intravenous antibiotics on board.
  • You may have persistent hematuria.
  • The stent may be uncomfortable with pain radiating to your affected kidney every time you urinate.
  • Your stent will be removed on a separate occasion in 6 weeks with a flexible cystoscopy under Local Anesthesia.
  • A follow-up appointment will be scheduled for 6 weeks to review your symptoms.
  • A further follow-up may be arranged with a CT IVP to check on the end result of the ureter.
  • DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!

 

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Wes Ureterotomy