Laparoscopy, surgical; ureteroneocystostomy without cystoscopy and ureteral stent placement
CPT4 code
Name of the Procedure:
Laparoscopy, surgical; ureteroneocystostomy without cystoscopy and ureteral stent placement
Summary
Laparoscopy with ureteroneocystostomy is a minimally invasive surgical procedure in which the surgeon re-implants the ureter into the bladder, correcting the flow of urine. This procedure is done without using cystoscopy or placing a ureteral stent.
Purpose
This procedure is primarily done to treat conditions where the ureter does not properly drain urine into the bladder. This can include ureteral strictures, obstructions, or vesicoureteral reflux. The goal is to restore normal urine flow, relieve pain or infections caused by blockages, and prevent kidney damage.
Indications
- Recurrent urinary tract infections
- Pain related to ureteral obstruction
- Vesicoureteral reflux
- Ureteral strictures or other obstructions
- Decreased kidney function due to urine backflow
Preparation
- Fasting for at least 8 hours prior to surgery
- Adjusting current medication intake as advised by the healthcare provider
- Pre-operative diagnostic tests, including blood work, urinalysis, and imaging studies like an ultrasound or CT scan to understand the condition better
Procedure Description
- The patient is given general anesthesia.
- Small incisions are made in the abdominal area.
- A laparoscope (a small camera) and surgical instruments are inserted through these incisions.
- The surgeon identifies the affected ureter and detaches it from its original position.
- The ureter is then re-implanted into a new location in the bladder to ensure proper urine flow.
- The incisions are closed with sutures or staples. The procedure avoids the use of cystoscopy and does not involve placing a temporary ureteral stent.
Duration
Typically, the surgery takes about 2 to 3 hours, depending on the complexity.
Setting
The procedure is usually performed in a hospital setting, often in an operating room equipped for laparoscopic surgery.
Personnel
- Urologic surgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Infection
- Bleeding
- Injury to surrounding organs
- Blood clots
- Scar tissue formation
- Risk of recurrent obstruction
- Temporary or persistent discomfort at incision sites
Benefits
- Relief from symptoms such as pain and recurrent infections
- Prevention of kidney damage
- Faster recovery and less pain compared to open surgery due to the minimally invasive nature
Recovery
- Hospital stay for 1 to 2 days post-surgery for monitoring
- Pain management using prescribed medications
- Gradual resumption of normal activities within 1 to 2 weeks
- Avoiding strenuous activities and heavy lifting for at least a month
- Follow-up appointments to monitor healing and the function of the ureter
Alternatives
- Endoscopic ureteral stent placement (less invasive but temporary)
- Open ureteroneocystostomy (more invasive with a longer recovery period)
- Observation and medical management (useful in less severe cases)
Patient Experience
- During the procedure: The patient will be under general anesthesia and will not feel anything.
- After the procedure: Some discomfort or pain at incision sites, managed with pain medication.
- Post-operative care involves minor activity restrictions and monitoring for any signs of complications like infection or excessive bleeding. Follow-up visits ensure proper recovery and function of the ureter.
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