52356 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, Gibbons or double-J type)

Name of the Procedure:

Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (e.g., double-J or Gibbons type).

Summary

This procedure involves using a thin, flexible tube with a camera (endoscope) to view the inside of the bladder, urethra, ureters, and kidney pelvis. It includes breaking down kidney stones and placing a stent to help urine flow from the kidneys to the bladder.

Purpose

It primarily addresses kidney stones causing blockage or infection. The goals are to remove or break down stones, alleviate pain, prevent infection, and restore normal urine flow.

Indications

• Persistent or recurring kidney stones
• Severe kidney pain or hydronephrosis (swelling of the kidney)
• Urinary tract infections associated with stone obstruction

Preparation

• Fasting for 6-8 hours prior to the procedure
• Temporary cessation of certain medications such as blood thinners
• Pre-procedure imaging tests (e.g., CT scan, ultrasound)

Procedure Description

1. Anesthesia is administered (general or spinal).
2. A cystoscope is inserted through the urethra into the bladder.
3. The ureteroscope is advanced into the ureter and kidney pelvis.
4. Lithotripsy is performed using laser or other energy sources to fragment stones.
5. An indwelling ureteral stent (double-J or Gibbons type) is inserted to ensure urine flow.
6. The instruments are removed, and the patient is taken to recovery.

Duration

Typically takes 1-2 hours.

Setting

Performed in a hospital or surgical center under sterile conditions.

Personnel

• Urologist or surgeon
• Anesthesiologist
• Surgical nurse
• Technicians

Risks and Complications

• Bleeding or infection
• Injury to the urinary tract
• Stone fragments causing blockage
• Stent-related discomfort or complications (e.g., migration)

Benefits

• Relief from pain and obstruction due to kidney stones
• Reduced risk of infection and kidney damage
• Restores normal urine flow

Recovery

• Monitoring in a recovery room for a few hours post-procedure
• Pain management with prescribed medications
• Instructions to keep hydrated to facilitate stone passage
• Avoid strenuous activity for a few days
• Follow-up appointment in 1-2 weeks to assess recovery and stent position

Alternatives

• Conservative management (pain control, hydration, and wait for stones to pass)
• Extracorporeal shock wave lithotripsy (ESWL)
• Percutaneous nephrolithotomy (PCNL) Each alternative has its pros and cons based on stone size, location, and patient health.

Patient Experience

• Mild discomfort during recovery, manageable with painkillers
• Possible blood in urine initially
• Temporary urinary symptoms due to stent (e.g., frequent urination, urgency) Comfort measures include staying hydrated and taking prescribed medications.