ureteroscopy

Ureteroscopy is needed to examine the urethra. With the help of an endoscopic device that is inserted inside, the doctor can examine in detail the mucous membrane, structure and condition of the urethra. Such a procedure is carried out even for children, it is safe and gives all the necessary information in order to correctly diagnose and cure the patient. Let’s take a closer look: how and why they do it, whether it is worth being afraid of where to undergo such a procedure.

Why is ureteroscopy necessary?

Ureteroscopy is needed for an accurate examination of the canal, the detection of diseases, and their elimination. The urethra is a tube-shaped organ through which urine passes from the bladder. It is different for men and women, therefore, female and male ureteroscopes are used for examination. Diseases in this area are associated with inflammation caused by bacteria, viruses, fungi. This phenomenon is often accompanied by pain and discomfort, disrupts sexual life. In a neglected state, urethral diseases lead to extensive inflammatory processes, infertility, and incontinence.

This examination technique is based on the introduction of the device into the area of ​​interest, which is why patients are often afraid of it. Learning how ureteroscopy is done will serve as a good psychological preparation. For examination, a ureteroscope is used – a device with a thin hollow tube and nozzles. The device is equipped with lighting and a camera, while passing through the channel, the data is transmitted to the monitor, while the image is enlarged 3 times. To study the genitourinary system, this is an extremely informative method, since the doctor receives a real-time picture, color, and can examine even the smallest changes in the organ.

Such a procedure requires certain skills from the doctor, high qualifications and experience. A very painstaking process can be fraught with risks for the patient if the doctor does not have the necessary competence. They do it only if ultrasound, CT or MRI do not provide the necessary information or they cannot be performed for some reason. If the doctor prescribes this examination, then it is exactly what is needed to solve the patient’s problem. In addition to a visual examination of the organ, ureteroscopy can be a method of treatment. For example, when narrowing the lumen with a ureteroscope, bougienage is done. The procedure also allows you to take a piece of tissue for a biopsy.

Ureteroscopy allows you to accurately determine the cause and location of the disease, conduct the necessary analysis, and determine an effective method of treatment. During the invasion (penetration), the doctor will do everything possible to speed up the process and reduce discomfort in the patient.

When she is appointed

Urethroscopy is directed after a visual examination and palpation (palpation), as a rule, the examination is prescribed by a venereologist, urologist or gynecologist. Before the invasion, the patient is given an ultrasound or other diagnostics – MRI, CT. However, such techniques provide less information than direct intervention. In some cases, ureteroscopy is the only way to clearly define the problem and its solution.

Indications for the procedure in men and women:

1. Urolithiasis – the formation of stones in the genitourinary system. Sometimes stones can be detected and removed with the help of ureteroscopy, in other cases other treatment is required.
2. Cysts and polyps are neoplasms that are usually clearly visible on ultrasound. Invasion is prescribed if you need to clarify the diagnosis.
3. Disturbed ejaculation – during the process, the doctor determines the cause of the problem, since many factors can cause such a violation.
4. Urethritis – inflammation of the urethra, occurs in both women and men. Accompanied by burning, pain, cystitis, bleeding.
5. Littreit and morganite – damage to the mucous glands of the Morganian lacunae, while the mucous membrane becomes inflamed, purulent discharge, redness appear.
6. Sexually transmitted diseases – can give complications in the form of urogenital inflammation.
7. Peptic ulcers and erosion – in the area of ​​the urethra and bladder are extremely rare.
8. Blood inclusions in the biological fluid: urine, secretions, semen.
9. Narrowing of the channel in one or more sections.
10. Acute disorders during urination: incontinence, difficulty in the process.

Invasion makes it possible to clarify the nature of the disease, to take a particle of tissue for analysis. Based on the information received, the urologist determines the treatment regimen; in some cases, passing the ureteroscope through the organ already serves as a treatment. Also, in chronic diseases, this technique is carried out to check the quality of therapy, the doctor determines whether there are changes, changes the treatment tactics.

How to prepare for it

Diagnosis is not carried out against the background of acute inflammation, since the intervention in this case complicates the disease. 2-3 days before the procedure, the patient is prescribed an antibiotic in tablets, sometimes they simply give an antibacterial injection on the day of the examination. This is necessary in order to prevent the likelihood of exacerbations. At the time of the procedure, the doctor must make sure that the patient is not allergic to antiseptics and anesthetics. The rest of the preparation is not required. Before the study itself, the patient must empty the bladder.

Features of

The procedure is carried out on an outpatient basis – in the doctor’s office or in a hospital. The patient takes off his clothes and changes into hospital clothes. The examination takes place in a special chair or on a table. The patient is comfortably located, before ureteroscopy it is very important to relax as much as possible, sedatives are offered to those who are especially sensitive. The patient puts the legs in special grooves so that they are slightly bent at the knees and spread apart. The genital area should be easily accessible to the doctor.

The process will be carried out by a urologist, assisted by a nurse. Be sure to prepare appliances, sterile cotton pads, disposable sheets. The doctor treats every detail of the ureteroscope with antiseptic agents. The external genital organs of the subject are also disinfected – it is absolutely not painful. After the preparations, the process itself begins, for women and men it proceeds the same way:

1. The doctor disinfects the vulva area so that no infection gets into the urethra during the procedure. Special solutions are used for this, they do not cause pain. If there are scratches or wounds in the examined area, a burning sensation will appear, which will quickly pass.
2. A suitable type of ureteroscope is selected for the patient. For women and men, they are different, in addition, the most suitable tube diameter is selected. To make the device easily pass through the organ, it is lubricated with medical glycerin. It is a safe substance that does not cause allergies or discomfort.
3. First of all, the doctor administers anesthesia. To examine women, an anesthetic with lidocaine is treated with a tube at the end of the ureteroscope. For men, an anesthetic gel is injected into the urethra itself, and there will be pain, but it will stop as soon as the substance begins to act. After the introduction of the gel, wait 3-5 minutes for it to take effect. From this point on, the patient will not feel pain, maximum – a feeling of pressure, just discomfort.
4. In some cases, general anesthesia is used. Patients with mental disorders, very sensitive children, local anesthesia is not enough. Any patient can choose between general anesthesia and anesthesia.
5. A special nozzle is put on the tip of the ureteroscope – an obturator. It is needed to protect the mucous membrane so that the device does not damage it during the study.
6. The doctor gently inserts the instrument tube through the urethra. If you only need to examine the anterior part, the procedure will be faster. To examine the back of the urethra, the device is advanced further.
7. Then the obturator is removed and the optical system is inserted into the tube. When removing the device from the organ, the doctor examines the condition of the urethra on the screen. If biomaterial is needed for analysis, it is taken with tiny forceps.
8. The process ends when the doctor examines the entire area of ​​interest: the bladder, ureter lobes, canal tube and other parts.

Additionally, the urologist feels the urethra and bladder. To prevent infection, the genitals are once again treated with an antiseptic. The technique may differ slightly, there are irrigation ureteroscopy and dry. For a better examination, the bladder is filled with air – it is dry, or with a special liquid – this is irrigation. At the same time, the filling is felt sick, but without sharp pains. Patient reviews show that irrigation is easier to tolerate. Such a manipulation is carried out when the ureteroscope has reached the bladder, and the organ is filled through it. Under the action of liquid or air, the area of ​​interest straightens, the mucous membrane is better visible. Other than that, the process is slightly different for men and women.

Women

Women are prescribed such an examination much less often than men. In most cases, this is due to stress urinary incontinence. The female urethra is wider and shorter than the male, so the operation is easier and faster. However, this anatomical feature has its drawback: it is easier for infections to reach the bladder through a short channel, so inflammatory processes are more common in women. For the same reason, during examinations of women, the entire bladder is examined, this is called diagnostic cystoscopy. The introduction of the device in this case is quick and easier for both the patient and the specialist himself.

In men

Since the male urethra is longer, the procedure takes a little longer. Also, the diameter of the channel is narrower than the female one, which makes it a little more difficult to advance the device tube. As a rule, the irrigation method is prescribed for the stronger sex, with which the walls of the organ expand smoothly, and the apparatus can pass more easily. Painful sensations happen during anesthesia, but they disappear as soon as the drug begins to act. During the operation, a feeling of discomfort is considered the norm, but with pain and tension, the process is stopped. The examination is continued after the patient calms down so that the muscles are relaxed.

Children

This technique is considered safe for both children and adults. For children, such a study is prescribed very rarely, but in exceptional cases, ureteroscopy for a child is the only way to diagnose and treat. It is done only under general anesthesia, otherwise the technique is the same.

Consequences and complications

Ureteroscopy is considered a low-traumatic and harmless research technique. It may seem quite dangerous to the patient, which is completely unjustified. It is carried out by an experienced specialist, under whose supervision possible risks are excluded. Manipulation, of course, is unpleasant, but it is transferred quite normally.

Rare complications include:

• infection;
• canal injury with a ureteroscope;
• bleeding after surgery or biopsy;
• pain during urination.

Bleeding after a biopsy is considered an acceptable norm, as are small passing pains in the urethra. However, if there is prolonged bleeding, fever, severe pain, weak urinary flow – this is the reason to urgently consult a doctor.

Contraindications to the procedure

It is impossible to conduct such an examination or treatment for people with acute inflammatory processes in the genitourinary system. An uncontrolled infection can spread during manipulations. Also, it is not prescribed after a heart attack or stroke, since such complications are incompatible with anesthesia and anesthesia. For the same reason, it is not always possible to diagnose patients with respiratory and cardiovascular problems. The doctor determines whether such manipulations can be prescribed to the patient after studying the medical history and examinations.

Important questions

Does it hurt

With the use of anesthesia, the process occurs without pain. Unpleasant sensations appear only at the time of the introduction of this anesthesia, which quickly pass. The main thing is not to be nervous, muscle tension complicates the task of the doctor and the patient himself. Entering the office, relax, tell the doctor about your concern, the session will not begin until the patient is ready. Additionally, you can ask for a sedative.

How long does it take

Depending on the goals, the process can take from 15 to 40 minutes. Diagnostic ureteroscopy is fast, most of it is preparation. If a biopsy or treatment is needed, it will take a little longer. In general, they try to carry out manipulations quickly and with maximum efficiency.

Where to do

You can undergo an examination or therapy with a ureteroscope in a public institution, private clinic, diagnostic center. When choosing between these options, it is better to give preference to specialized clinics. The course of the operation depends on the quality and generation of devices, for example, new equipment is distinguished by more flexible and thin tubes, effective protection. It is also important to pay attention to the experience of the medical staff, the reputation of the clinic. It is better to look for reviews on hospital websites or forums.

How much is it

The cost of the service is affected by the range of work, the quality of equipment, the reputation of the clinic. Diagnostic manipulations cost around $20-40 in a private clinic. The cost of medical services will be 100-150 dollars. At the same time, in some institutions, anesthesia is not included in the price, so you will have to pay about another 10-20 dollars for it. In total, such a service will cost 200-250 dollars in the middle price segment.