50436 Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, with postprocedure tube placement, when performed

Name of the Procedure:

Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (e.g., ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, with postprocedure tube placement, when performed. Common terms include percutaneous nephrostomy tract dilation.

Summary

In layman's terms, this is a minimally invasive procedure where a doctor uses imaging technology to widen an existing pathway in the kidney. This pathway is used to address urinary issues, often involving the placement of a tube for drainage.

Purpose

This procedure addresses blockages or obstructions in the urinary tract, often caused by kidney stones, tumors, or strictures. The goal is to allow urine to flow properly from the kidneys to the bladder or to facilitate other urological treatments.

Indications

• Kidney stones that obstruct urine flow.
• Tumors creating blockages in the urinary tract.
• Strictures or narrowing of the urinary channels.
• Infections or abscesses requiring drainage.

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments to certain medications, especially blood thinners, might be necessary.
• Pre-procedure imaging tests, like ultrasounds or CT scans, are often required to plan the procedure.

Procedure Description

1. The patient is positioned suitably, typically on their side.
2. Anesthesia or sedation is administered.
3. Using imaging guidance (ultrasound and/or fluoroscopy), a physician locates the existing tract.
4. The tract is gradually dilated using specialized instruments.
5. If required, a drainage tube (nephrostomy tube) is placed to ensure urine can flow properly.
6. Real-time imaging ensures accurate placement and confirms the success of the procedure.

Duration

The procedure typically lasts about 1 to 2 hours.

Setting

This procedure is usually performed in a hospital's interventional radiology suite or operating room.

Personnel

• Interventional radiologist or urologist
• Radiology technologists
• Nursing staff
• Anesthesiologist or nurse anesthetist

Risks and Complications

• Bleeding or hematomas
• Infection at the site of the tract
• Injury to surrounding tissues or organs
• Allergic reactions to contrast material used in imaging
• Potential need for additional procedures in case of complications

Benefits

• Relieves urinary blockage and associated pain.
• Can prevent kidney damage by allowing proper urine drainage.
• Quick recovery time compared to more invasive surgeries.

Recovery

• Patients may need to stay in the hospital for a short period for observation.
• Follow-up imaging tests may be required to ensure the tube is in place and functioning properly.
• Patients should avoid strenuous activities for a few days.
• Instructions on tube care and hygiene will be provided.

Alternatives

• Ureteroscopy or laser lithotripsy for stone removal.
• Open surgery, which is more invasive and has a longer recovery time.
• Observation and medical management, which might not be suitable for severe obstructions.

Patient Experience

• Some discomfort or pain may be felt during and after the procedure, which can be managed with pain medications.
• Mild pain or soreness in the back or side where the tube is placed.
• Full recovery typically occurs within a week, though the tube may need long-term management.