50387 Removal and replacement of externally accessible nephroureteral catheter (eg, external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation

Name of the Procedure:

Removal and replacement of externally accessible nephroureteral catheter (e.g., external/internal stent) with fluoroscopic guidance, including radiological supervision and interpretation.

Summary

This procedure involves the removal and replacement of a nephroureteral catheter, which is a tube inserted into the kidney and ureter to help drain urine. The procedure uses fluoroscopic imaging to guide the catheter placement, and is performed under radiological supervision.

Purpose

This procedure addresses conditions where the kidney and ureter are blocked or have an obstruction, to facilitate proper urine drainage. The goal is to replace a malfunctioning or infected nephroureteral catheter with a new one, ensuring continued kidney function and reducing discomfort or risk of infection.

Indications

• Obstruction in the ureter or kidney causing urine retention.
• Infection or malfunction of the existing nephroureteral catheter.
• Symptoms such as flank pain, hematuria (blood in urine), or signs of kidney infection.
• Indications from imaging studies suggesting catheter replacement is necessary.

Preparation

• Patients may be instructed to fast for a few hours before the procedure.
• Blood tests and imaging studies (like an ultrasound or CT scan) may be required beforehand.
• Patients should inform the doctor of any allergies, especially to contrast dye or anesthetics.
• Adjustments to medication (e.g., blood thinners) may be necessary.

Procedure Description

1. The patient lies on an X-ray table.
2. Local or general anesthesia is administered to minimize discomfort.
3. Using fluoroscopic guidance, the existing nephroureteral catheter is carefully removed.
4. A new catheter is then inserted into the kidney and ureter.
5. The correct placement of the new catheter is confirmed using fluoroscopy.
6. The procedure, including radiological supervision, ensures proper positioning and functionality of the catheter.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This procedure is usually performed in a hospital's radiology department or an outpatient surgical center.

Personnel

• An interventional radiologist or urologist performs the procedure.
• Radiology technicians assist with imaging and fluoroscopy.
• Nurses and possibly an anesthesiologist or nurse anesthetist are also involved.

Risks and Complications

• Infection at the insertion site.
• Bleeding or damage to the kidney or ureter.
• Allergy or adverse reaction to contrast dye or anesthesia.
• Catheter displacement or blockage shortly after the procedure.

Benefits

• Restores proper urine drainage from the kidney.
• Reduces the risk of infection and kidney damage due to urine retention.
• Alleviates symptoms like pain and hematuria.
• Immediate improvement in urine flow can typically be noticed.

Recovery

• Patients may be observed for a few hours after the procedure.
• Instructions include keeping the catheter area clean and dry.
• Activity may be limited for a short period to allow for healing.
• Follow-up appointments are necessary to ensure the catheter remains functional.
• Pain management may involve prescribed medications or over-the-counter pain relievers.

Alternatives

• Ureteral stenting via cystoscopy.
• Percutaneous nephrostomy for direct drainage.
• Medical management of underlying conditions causing the obstruction.
• Surgery to remove the obstruction.

Patient Experience

Patients may feel some discomfort or pressure during the procedure, depending on the anesthesia used. Mild pain or soreness at the insertion site is common post-procedure, which can be managed with pain relief medications. Proper adherence to post-procedure care guidelines enhances recovery and comfort.