UTEREROSCOPY

 

Ureteroscopy is a medical procedure used to diagnose and treat problems in the urinary tract, specifically in the ureters and kidneys. The ureters are the tubes that carry urine from the kidneys to the bladder.

Here's an overview of what ureteroscopy involves:

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1. Procedure Type: Ureteroscopy is a minimally invasive procedure. It involves the use of a ureteroscope, which is a long, thin, flexible or rigid tube equipped with a light and camera at its tip.

2. Diagnosis and Treatment: It is commonly used for diagnosing and treating kidney stones. The ureteroscope allows the doctor to see the stones directly and then remove them or break them into smaller pieces that can pass out of the body in urine. Additionally, it can be used for diagnosing abnormal growths, strictures (narrowing of the ureter), and for taking biopsies of suspicious areas.

3. Procedure Process: During the procedure, the ureteroscope is inserted through the urethra and bladder and then into the ureter and possibly the kidney. No incisions are made in the skin. This procedure is often done under general anesthesia, although local or spinal anesthesia may be used in some cases.

                                                                                                 

Through a cystoscope, the bladder (cystoscopy), urethra (urethroscopy), and ureteral orifices (ureteroscopy)

can be visualized.

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In a retrograde pyelogram, contrast is injected into the ureter so that the ureter and kidney can be visualized under fluoroscopy.

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                                                          Anesthetic Implications for Ureteroscopy

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Anesthesia type: General, regional anesthesia, sedation, local anesthesia

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Airway: ETT or LMA

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Preoperative:

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• Ureteroscopy is used to evaluate the upper urinary tract, including the ureter, renal pelvis, and kidneys

• If neuraxial anesthesia is done, a T6 or a T10 level is necessary for upper tract and lower tract instrumentation

• Autonomic hyperreflexia can occur in individuals who have sustained a prior spinal cord injury (especially injuries at T6 and above)

• Autonomic hyperreflexia is associated with severe hypertension, bradycardia, and arrhythmias

• A cystoscopy is commonly done 

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Intraoperative:

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• Position: lithotomy

• Duration: 30-90 minutes

• Often simple and brief

• Minimal surgical stimulation if diagnostic

• More complex procedures involve tumor resection, ureteral dilatation, stenting, or stone extraction

• Lithotomy position: decreases functional residual capacity, increases venous return, increases mean arterial pressure, and can cause neuropathies or neuropraxia

• If lasers are used to break the stone, eye protection for staff and the patient may be required

• After the stone is fragmented and removed, a stent is often placed to prevent obstruction from ureteral edema or fragments

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Postoperative:

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• Pain management

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Complications:

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• Ureteral perforation

• Pyelonephritis

• Infection

• Formation of scar tissue in ureter

• Bleeding

• Injury to adjacent organs

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Sources:

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Elisha, S. (2010). Case Studies in Nurse Anesthesia.

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Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. 

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Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). 

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Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.

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