Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy
CPT4 code
Name of the Procedure:
Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy. Common names: Kidney endoscopy, Nephrostomy endoscopy, Pyeloscopic surgery
Summary
This procedure involves using an endoscope to examine the inside of the kidney through an existing nephrostomy (a tube inserted into the kidney) or pyelostomy. It can include flushing the area, taking imaging scans, making small cuts, or removing pieces of tissue for biopsy, typically without additional radiologic services.
Purpose
This procedure addresses kidney problems such as obstructions, stones, tumors, or infections. The goal is to diagnose, treat, and relieve symptoms, restore kidney function, and prevent complications.
Indications
- Persistent kidney stones or obstructions
- Suspected or known tumors in the kidney
- Chronic infections unresponsive to treatment
- Unexplained blood in the urine (hematuria)
- Conditions discovered during other nephrostomy procedures
Preparation
- Patient may need to fast for several hours before the procedure.
- Adjustment or temporary discontinuation of certain medications, especially blood thinners.
- Pre-procedure imaging like CT scans or ultrasounds.
- Routine blood tests to check kidney function and overall health.
Procedure Description
- Anesthesia: Administer local, regional, or general anesthesia depending on the case.
- Endoscope Insertion: Insert the endoscope through the nephrostomy or pyelostomy tube.
- Inspection and Treatment: Examine the interior of the kidney, flush the area if needed, possibly take X-ray images (ureteropyelography), and use tools to fulgurate (cauterize) tissue or make incisions. Biopsies may also be taken.
- Completion: Remove the endoscope and ensure the nephrostomy or pyelostomy tube is correctly positioned.
Duration
Typically takes between 30 minutes to 2 hours, depending on complexity.
Setting
Performed in a hospital surgical suite or specialized outpatient clinic.
Personnel
- Urologist or specialized surgeon
- Anesthesiologist
- Surgical nurses and technicians
Risks and Complications
- Infection
- Bleeding
- Injury to the kidney or surrounding organs
- Pain or discomfort at the nephrostomy site
- Rare: Anesthesia-related complications
Benefits
- Immediate relief from obstructions and pain
- Accurate diagnosis from direct visualization and biopsy
- Minimally invasive compared to open surgery, resulting in quicker recovery
Recovery
- Post-procedure observation for a few hours to ensure stability.
- Pain management with prescribed medications.
- Instructions for nephrostomy tube care.
- Return to normal activities typically within a few days to a week.
- Follow-up appointments to monitor recovery and address any concerns.
Alternatives
- Extracorporeal shock wave lithotripsy (for kidney stones)
- Medication management for infections and minor obstructions
- Percutaneous nephrolithotomy (another form of kidney stone removal)
Patient Experience
Patients may feel slight discomfort during recovery, managed with pain relief medications. Most experience significant symptom relief shortly after the procedure and can resume daily activities within a few days.