Theatre Radiography

Urology Radiography

Practical information for student radiographers regarding the role of radiographers during urology procedures, based on real-case scenarios. This includes an explanation of what the role entails and definitions of relevant medical terminology.

CASE 1: CHECK CYSTOSCOPY +/- BIOPSY +/- LEFT URETEROSCOPY AND LASER:

  • Cystoscopy: This procedure involves inserting a cystoscope (a thin tube with a light and camera) into the bladder through the urethra to inspect the inner surface. It can detect bladder tumors, stones, or other abnormalities.
  • Biopsy: A sample of tissue is taken from the bladder for further examination under a microscope.
  • Ureteroscopy: A similar procedure to cystoscopy but the scope is passed further up into the ureters (the tubes that carry urine from the kidneys to the bladder).
  • Laser: During ureteroscopy, if a stone is found, a laser can be used to break it into smaller fragments that can pass out in the urine.
  1. RIGHT URETEROSCOPY (DIAGNOSTIC):
    • This is a ureteroscopic examination of the right ureter, typically to identify the cause of symptoms or to locate a stone or tumor.
  2. CYSTOSCOPY AND EXCHANGE OF RIGHT URETERIC STENT:
    • After a ureteroscopy, a stent (a small plastic tube) may be placed in the ureter to prevent blockage and allow small stone fragments to pass. Over time, these stents may need to be exchanged, which is done cystoscopically.
  3. CYSTOSCOP, CYSTOLITHOLAPAXY (LASER OR LITHOCAST) +/- OPEN:
    • Cystolitholapaxy: If bladder stones are present, they can be crushed using a device or laser, making them easier to pass or be removed.
    • Lithoclast: This is a device used to break up stones.
    • Open: This might refer to the option of doing an open surgery if the other methods are not feasible or unsuccessful.
  4. RIGHT URS +/- BIOPSY:
    • This refers to a ureteroscopy of the right side, with the option of taking a biopsy if needed.
  5. CYSTOSCOPY AND TUR BIOPSY (RECURRENCE):
    • TUR Biopsy: Transurethral resection (TUR) is a procedure to remove tissue from the bladder using a resectoscope inserted into the bladder through the urethra. It can be used to remove tumors or take biopsies. The term “recurrence” suggests this might be a follow-up procedure after a previous one, possibly due to the recurrence of a tumor or abnormality.

Regarding the procedure with the wire and stent you mentioned:

  • The wire acts as a guide during the procedure. Once the wire is in place and its position is confirmed with X-ray, instruments or stents can be passed over the wire into the correct position in the urinary system.
  • A stent can be placed to allow urine to flow from the kidney to the bladder if there’s an obstruction, or to allow healing after a procedure.

Key Responsibilities:

  1. Patient Identification: Verify the patient’s identity and relevant details.
  2. Pregnancy Status Check: Confirm pregnancy status for female patients of reproductive age.
  3. Radiation Control: Ensure radiation doses are kept as low as reasonably achievable (ALARA principle).
  4. Equipment Set-up and operation: Properly position and adjust the C-arm or other imaging equipment throughout the procedure.
  5. Image Quality: Obtain clear and accurate images to guide the surgical team.
  6. Communication: Maintain effective communication with the surgical team and patient.
  7. Safety Protocols: Adhere to all safety guidelines and protocols.
  8. Documentation: Record all relevant details of the procedure and radiation exposure.
  9. Infection Control: Ensure equipment cleanliness and adhere to theatre sterility standards.