INSPECTION/EXAMINATION OF

THE URETER ± BIOPSY

Procedure Specific Information

What is the evidence base for this information?

This publication includes advice from consensus panels, the British Association of
Urological Surgeons, the Department of Health and evidence-based sources. It is,
therefore, a reflection of best urological practice in the UK. It is intended to supplement any
advice you may already have been given by your GP or other healthcare professionals.
Alternative treatments are outlined below and can be discussed in more detail with your
Urologist or Specialist Nurse.

What does the procedure involve?

Examination of the ureter and kidney ± biopsy, with possible placement
of a plastic tube or stent. This procedure usually includes cystoscopy
and x-ray screening

What are the alternatives to this procedure?

Open surgery, other X-ray investigations or further observation

What should I expect before the procedure?

You will usually be admitted on the same day as your surgery. You will normally receive an
appointment for pre-assessment to assess your general fitness, to screen for the carriage
of MRSA and to perform some baseline investigations. After admission, you will be seen by
members of the medical team which may include the Consultant, Specialist Registrar,
House Officer and your named nurse.

You will be asked not to eat or drink for 6 hours before surgery and, immediately before the
operation, you may be given a pre-medication by the anaesthetist which will make you dry-
mouthed and pleasantly sleepy.

Please be sure to inform your surgeon in advance of your surgery if you have any of the
following:
 an artificial heart valve
 a coronary artery stent
 a heart pacemaker or defibrillator
 an artificial joint
 an artificial blood vessel graft

The British Association of Urological Surgeons

35-43 Lincoln’s Inn Fields
London
WC2A 3PE

Tel. 020 7869 6950

Fax. 020 7404 5048

admin@baus.org.uk
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  a neurosurgical shunt
 any other implanted foreign body
 a regular prescription for Warfarin, Aspirin or Clopidogrel (Plavix®)
 a previous or current MRSA infection
 a high risk of variant-CJD (if you have received a corneal transplant, a
neurosurgical dural transplant or previous injections of human-derived
growth hormone)

At some stage during the admission process, you will be asked to sign the second part of
the consent form giving permission for your operation to take place, showing you
understand what is to be done and confirming that you wish to proceed. Make sure that
you are given the opportunity to discuss any concerns and to ask any questions you may
still have before signing the form.

Fact File 1 • The NHS Constitution

Same-Sex Accommodation
As a result of the new NHS constitution, the NHS is committed to providing same-
sex accommodation in hospitals by April 2010. This is because feedback from
patients has shown that being in mixed-sex accommodation can compromise their
privacy. The NHS pledges that:
 sleeping and washing areas for men and women will be provided
 the facilities will be easy to get to and not too far from patients’ beds

To help accomplish this, the Department of Health has announced specific

measures designed to “all but eliminate mixed-sex accommodation” by 2010.
These include:
 more money for improvements in hospital accommodation
 providing help and information to hospital staff, patients and the public
 sending improvement teams to hospitals that need extra support
 introducing measures so that the Department can see how hospitals are
progressing

What happens during the procedure?

Normally, a full general anaesthetic will be used and you will be asleep throughout the
procedure.

You will usually be given injectable antibiotics before the procedure, after checking for any
allergies.

A telescope is inserted into the bladder through the water pipe (urethra). Under X-ray
screening, a flexible guidewire is inserted into the affected ureter up to the kidney. A longer
telescope (either rigid or flexible) is then inserted into the ureter and passed up to the

INSPECTION/EXAMINATION OF
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kidney.

Any abnormal areas in the ureter or kidney are biopsied and it may be necessary to leave a
ureteric stent and/or a bladder catheter in place after the operation.

What happens immediately after the procedure?

In general terms, you should expect to be told how the procedure went and you should:

 ask if what was planned to be done was achieved

 let the medical staff know if you are in any discomfort
 ask what you can and cannot do
 feel free to ask any questions or discuss any concerns with the ward staff
and members of the surgical team
 ensure that you are clear about what has been done and what is the next
move

If a bladder catheter has been inserted, this is usually removed on the

day after surgery. You will be able to go home once you are passing
urine normally.

The average hospital stay is 1 day

Are there any side-effects?

Most procedures have a potential for side-effects. You should be reassured that, although
all these complications are well-recognised, the majority of patients do not suffer any
problems after a urological procedure.

Common (greater than 1 in 10)

 Mild burning or bleeding on passing urine for short period after operation
 Temporary insertion of a bladder catheter
 Insertion of ureteric stent with a further procedure to remove it
 No guarantee of cure as this is often a diagnostic procedure only

Occasional (between 1 in 10 and 1 in 50)

 Kidney damage or infection needing further treatment
 Failure to pass the telescope if the ureter is narrow

Rare (less than 1 in 50)

 Finding cancer requiring additional therapy
 Damage to the ureter with need for open operation or tube placed into
kidney directly from the back to allow any leak to heal
 Very rarely, scarring or stricture of the ureter requiring further procedures

INSPECTION/EXAMINATION OF
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Hospital-acquired infection
 Colonisation with MRSA (0.9% - 1 in 110)
 Clostridium difficile bowel infection (0.2% - 1 in 500)
 MRSA bloodstream infection (0.08% - 1 in 1250)

The rates for hospital-acquired infection may be greater in high-risk patients e.g. with long-
term drainage tubes, after removal of the bladder for cancer, after previous infections, after
prolonged hospitalisation or after multiple admissions.

What should I expect when I get home?

By the time of your discharge from hospital, you should:

 be given advice about your recovery at home

 ask when to resume normal activities such as work, exercise, driving,
housework and sexual intimacy
 ask for a contact number if you have any concerns once you return home
 ask when your follow-up will be and who will do this (the hospital or your
GP)
 ensure that you know when you will be told the results of any tests done on
tissues or organs which have been removed

When you leave hospital, you will be given a “draft” discharge summary
of your admission. This holds important information about your inpatient
stay and your operation. If you need to call your GP for any reason or to
attend another hospital, please take this summary with you to allow the
doctors to see details of your treatment. This is particularly important if
you need to consult another doctor within a few days of your discharge.

When you get home, you should drink twice as much fluid as you would normally to flush
your system through and minimise any bleeding.

You may experience pain in the kidney over the first 24-72 hours, due to the swelling
caused by insertion of the instrument or by the presence of a stent. Anti-inflammatory
painkillers will help this pain which normally settles after 72 hours.

It may take at least 10 days to recover fully from the operation. You should not expect to
return to work within 7 days.

What else should I look out for?

If you develop a fever, severe pain on passing urine, inability to pass urine or worsening
bleeding, you should contact your GP immediately. Small blood clots or debris may also
pass down the ureter from the kidney, resulting in renal colic; in this event, you should
contact your GP immediately

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Are there any other important points?
If a biopsy has been taken, it may take 14-21 days before these are available. It is normal
practice for the results of all biopsies to be discussed in detail at a multi-disciplinary meeting
before any further treatment decisions are made. You and your GP will be informed of the
results after this discussion.

If you have any continuing problems regarding the results, you can telephone the Specialist
Nurses or speak to your GP at his/her surgery.

Depending on the underlying problem, an outpatient appointment, further treatment or

another admission may be arranged for you before you leave the hospital. Your Consultant
or named nurse will explain the details of this to you.

If a stent has been inserted, you will be informed before your discharge when the stent
needs to be removed. Ureteric stents are usually removed in the Day Surgery Unit under
local anaesthetic. A specific information sheet on what to expect with a ureteric stent is
available from the ward or from the Specialist Nurse.

Driving after surgery

It is your responsibility to ensure that you are fit to drive following your surgery. You do not
normally need to notify the DVLA unless you have a medical condition that will last for
longer than 3 months after your surgery and may affect your ability to drive. You should,
however, check with your insurance company before returning to driving. Your doctors will
be happy to provide you with advice on request.

Is there any research being carried out in this area?

Before your operation, your surgeon or Specialist Nurse will inform you
about any relevant research studies taking place, and, in particular, if
any surgically-removed tissue may be stored for future study. If this is
the case, you will be asked if you wish to participate and, if you agree,
to sign a special form to consent to this.

All surgical procedures, even those not currently the subject of active research, are
subjected to rigorous clinical audit so that we can analyse our results and compare them
with those of other surgeons. In this way, we can learn how to improve our techniques and
our results; this means that our patients will get the best treatment available.

Who can I contact for more help or information?

For further information on the internet, here are some useful sites to explore:

www.rcseng.ac.uk/patient_information/internet_sources
www.patient.co.uk
www.patientinformation.org.uk
www.rcoa.ac.uk (for information about anaesthetics)

INSPECTION/EXAMINATION OF
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 www.prodigy.nhs.uk.PILs
www.nhsdirect.nhs.uk
www.besttreatments.co.uk

What should I do with this information?

Thank you for taking the trouble to read this publication. If you wish to sign it and retain a
copy for your own records, please do so below.

If you would like a copy of this publication to be filed in your hospital records for future
reference, please let your Urologist or Specialist Nurse know. However, if you do agree to
proceed with the scheduled procedure, you will be asked to sign a separate consent form
which will be filed in your hospital record. You will, if you wish, be provided with a copy of
this consent form.

I have read this publication and I accept the information it provides.

Signature............................................................... Date...........................................

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How can I get information in alternative formats?
Please ask your local NHS Trust or PALS network if you require this information in other
languages, large print, Braille or audio format.

Most hospitals are smoke-free. Smoking increases the severity of

some urological conditions and increases the risk of post-operative
complications. For advice on quitting, contact your GP or the NHS
Smoking Helpline free on 0800 169 0 169

Disclaimer
While every effort has been made to ensure the accuracy of the information contained in
this publication, no guarantee can be given that all errors and omissions have been
excluded. No responsibility for loss occasioned by any person acting or refraining from
action as a result of the material in this publication can be accepted by the British
Association of Urological Surgeons Limited.

Fact File 2 • The NHS Constitution

Patients’ Rights & Responsibilities
The constitution, as a result of extensive discussions with staff and the public, sets
out new rights for patients which will help improve their experience within the NHS.
These new rights include:
 a right to choice and a right to information that will help them make that
choice
 a right to drugs and treatments approved by NICE when it is considered
clinically appropriate
 a right to certain services such as an NHS dentist and access to
recommended vaccinations
 the right that any official complaint will be properly and efficiently
investigated, and that they be told the outcome of the investigations
 the right to compensation and an apology if they have been harmed by
poor treatment

The constitution also lists patient responsibilities, including:

 providing accurate information about their health
 taking positive action to keep themselves and their family healthy
 trying to keep appointments
 treating NHS staff and other patients with respect
 following the course of treatment that they are given
 giving feedback, both positive and negative, after treatment

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