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Excision or unroofing of cyst(s) of kidney

CPT4 code

Name of the Procedure:

Excision or Unroofing of Kidney Cyst(s)


This procedure involves the surgical removal or opening of cysts located in the kidneys. Kidney cysts are fluid-filled sacs that can sometimes cause pain, infection, or other complications if left untreated.


The procedure aims to relieve symptoms caused by cysts, such as abdominal pain or discomfort, and mitigate potential complications like infection or hypertension. It also seeks to ensure that the kidney functions properly without obstruction or damage from the cysts.


  • Persistent, severe kidney pain
  • Infected or ruptured kidney cysts
  • Evidence of kidney dysfunction
  • Hypertension related to kidney cysts
  • Enlargement of cysts causing pressure on other organs


  • Patients may need to fast for 8 hours prior to the procedure.
  • Blood tests and imaging studies (like ultrasound, MRI, or CT scans) are performed to assess the cysts and overall kidney health.
  • Patients might have to adjust or stop taking certain medications, such as blood thinners.

Procedure Description

  1. The patient is given anesthesia (general or local, depending on the case).
  2. The surgeon makes a small incision to access the kidney.
  3. Using specialized instruments, the surgeon excises (removes) the cyst or performs unroofing (draining and removing the top part of the cyst).
  4. The area is then inspected for any remaining cyst tissue and complications.
  5. Incisions are closed with sutures.


The procedure typically takes about 1-2 hours, but this can vary depending on the number and size of cysts.


The procedure is usually performed in a hospital operating room or a surgical center.


  • Surgeon (urologist or general surgeon)
  • Anesthesiologist
  • Surgical nurses
  • Sometimes an interventional radiologist

Risks and Complications

  • Infection at the incision site or within the kidney
  • Bleeding during or after the procedure
  • Damage to surrounding kidney tissue
  • Recurrence of cysts
  • Rarely, loss of kidney function


  • Relief from pain and other symptoms caused by kidney cysts
  • Prevention of potential complications like infection or high blood pressure
  • Improved kidney function and overall health


  • Patients usually stay in the hospital for 1-2 days for monitoring.
  • Mild pain or discomfort at the incision site can be managed with pain medication.
  • Normal activities can typically be resumed within 1-2 weeks.
  • Follow-up appointments are necessary to monitor recovery and ensure cysts do not return.


  • Aspiration and sclerotherapy: draining the cyst and filling it with a sclerosing agent.
  • Observation: if the cysts are not causing symptoms, they may simply be monitored.
  • Each alternative has its own risks and benefits; for instance, aspiration is less invasive but might not prevent recurrence.

Patient Experience

  • During the procedure, patients will be under anesthesia and not feel pain.
  • Post-procedure, patients might experience some soreness or discomfort, which can be managed with pain relief medications.
  • It's normal to feel tired and need to rest for several days following the surgery.

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