Dilatation and stenting

Dilataion and stenting operation is performed to remove obstruction in ureter. Newer approach are adopted for initial management of ureteric strictures. Contemporary urologists resort to endourological interventions since these are less invasiveness and require less operative time. This also benefits patient by minimizing postoperative pain and helps rapid recovery reducing days of hospital stay. These are as safe as any other traditional surgeries and blood transfusion may not be necessary.

Length of Surgery:

3- 4 hours.

Diagnosis:

Procedure of Dilatation and stenting is precededbyfollowing diagnosis tests:

  • Physical exam and complete Medical history.
  • KUB ( abdominal X-ray)
  • EKG (electrocardiogram)
  • CBC (complete blood count)
  • PT / PTT (blood coagulation profile)
  • Comprehensive Metabolic Panel (blood chemistry profile)
  • Urinalysis
  • Renal ultrasound: grade of hydronephrosis?
  • Intravenous urography or abdominal CT
  • Renal scintigraphy
  • Endoscopy: Retrograde pyelography and ureterorenoscopy
  • During endoscopy, biopsy of the stricture is necessary in case of unclear etiology.

Treatment:

  • Endoscopic Baloon Dilatation
  • Ureteral stenting
  • Endocopic ureterotomy

Preparation:

Certain medications to be specifically avoided pre surgery:

  • Aspirin.
  • Ibuprofen Motrin.
  • Voltaren, Plavix, Lovenox, Vioxx, Celebrex.
  • Advil, Ticlid, Alka Seltzer, Coumadin, Vitamin E.
  • Arthritis medications: avoided since before a week of the surgery otherwise it can cause bleeding during the surgery.
  • In case of UTI Urinary Tract Infection, it should be treated before the surgery by prescribed antibiotics.
  • In case of severe lung/ heart conditions, it is advisable to exercise extra caution before and during the procedure

Procedure:

Endocopic Balloon Dilatation-
After confirming the site and length of ureteric stricture by pyelography and insertion of a guide wire, a balloon dilatator is introduced. Dilatation is done to a diameter of 4–6 mm. Placement of a ureteral stent (DJ) is done for 2–4 weeks. The success rate is 50–75%. Balloon dilatation is especially suitable for short segment strictures of less than 2 cm and for strictures after lithotripsy of ureteral stones.
Ureteral stenting –
Ureteral stenting is the initial treatment of symptomatic hydronephrosis after endoscopic diagnosis (see above). In conditions with possible spontaneous healing and resolution of the ureteral stricture, the ureteral stent can be removed after a few weeks (e.g. infections).
Endocopic ureterotomy –
Guided by retrograde (or antegrade) pyelography, a guide wire is inserted and the stricture ( narrowed obstruction) is cut under endoscopic vision. Cold knife (without cauterization) or laser fibers techniques are adopted during ureterotomy. A thick ureteral stent is placed for 8–10 weeks following ureterotomy.

Risks:

  • Bleeding after the operation
  • Infection
  • Poor wound healing ( following open surgery)
  • Fever.
  • Fatigue.
  • Urinary abnormalities.
  • Infection.
  • Lower body aches.

Follow- up:

  • 24 hour surveillance.
  • Visit doctor: for removal of cathedral after surgery.
  • Emergency Follow up:
  • Chest pain/ breathing difficulty.
  • Vomiting/ nausea
  • Worsening pain .
  • Large amounts of blood clots in the urine.
  • Difficult/ painful voiding and fully emptying the bladder.
  • Hospital stay for one to three days after the procedure.

All above, treatments are finalized taking into consideration the overall health, severity, age and other ailments of the patient. Only a well experienced urologist should perform the above treatment.