Prepare for the unpredictable during ureteroscopy
Exploring real-world cases and resolutions for managing patients with a tight or intramural ureter or UPJ during ureteroscopy.
Performing ureteroscopy is a straightforward procedure to assess and treat kidney stone disease, until you encounter a patient with a ureter that’s smaller than average, possibly related to the disease process of kidney stones itself or just natural anatomic variance. “A tight or intramural ureter can prevent you from being able to pass your scope to assess or begin treatment,” said Julie Riley, MD, associate professor of urology at the University of Arkansas Medical Sciences College of Medicine in Little Rock.
Should you incise the tissue, try to force the scope through or place a stent to gradually increase ureter size over time and schedule a second surgery? It can be difficult to know what to do.
“It’s an unpredictable yet common scenario that’s not well researched,” Dr. Riley said. But what is known is that the case will likely take more time than you planned for and disrupt the efficiency of your patient flow.
In Saturday’s “ Second Opinion Cases: Unable to Access Tight Ureter: Intramural Ureter and Ureteropelvic Junction (UPJ) Obstruction,” Dr. Riley, along with Matthew Bultitude, MD, a consultant urological surgeon at Guys Hospital in London, and Justin Ziemba, MD, MSEd, assistant professor of urology in surgery at the Perelman School of Medicine at the University of Pennsylvania, will present lessons they learned from tight ureter and ureteropelvic junction obstruction cases that initially prevented them from performing ureteroscopy at the time of surgery. “We will highlight different scenarios we’ve encountered in our daily practices both from a technical standpoint and how to manage patient expectations,” Dr. Riley said.
Be prepared to come away with ideas that have worked in the real world and gain a broad perspective of the impact of a tight and intramural ureter and UPJ situations on the patient experience and your workflow. Overall, “we have to be very personalized as we care for patients with a tight or intramural ureter or UPJ,” Dr. Riley said. “There is no one right way to resolve the situation. But it’s important to be ready and prepared to consider all of the options so you can feel a little more comfortable whenever the scenario arises.”
