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Removal (via snare/capture) and replacement of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation

CPT4 code

Name of the Procedure:

Removal (via snare/capture) and Replacement of Internally Dwelling Ureteral Stent via Percutaneous Approach, including Radiological Supervision and Interpretation.

Summary

This procedure involves removing an existing ureteral stent and placing a new one, guided by imaging tools, through a small incision in the skin.

Purpose

The primary purpose is to replace a ureteral stent that has either become occluded, displaced, or requires updating to ensure proper urine flow from the kidney to the bladder.

Indications

  • Persistent urinary tract infections
  • Blockage or narrowing of the ureter
  • Kidney stones
  • After certain types of urinary surgeries
  • Assessment of improper urine drainage from the kidney

Preparation

  • Fasting for at least 6 hours before the procedure.
  • Adjustment or temporary cessation of certain medications (e.g., blood thinners).
  • Pre-procedure imaging tests such as ultrasound or CT scans.
  • Blood tests to assess kidney function and clotting status.

Procedure Description

  1. Patient Preparation: The patient is positioned on the procedure table, and a local or general anesthetic is administered.
  2. Imaging: Radiological imaging (X-ray, fluoroscopy) is used to locate the stent.
  3. Incision: A small incision is made in the skin and a guidewire is introduced percutaneously.
  4. Snare/Capture: A snare or capture device is used to grasp and remove the old ureteral stent.
  5. Reassessment: The ureter and kidney are reassessed via imaging.
  6. Replacement: A new stent is placed using guidewires and imaging guidance.
  7. Final Check: Post-placement imaging ensures the new stent is positioned correctly.

Duration

Typically, the procedure takes about 1-2 hours.

Setting

The procedure is usually performed in a hospital's catheterization lab or a specialized radiology suite.

Personnel

  • Interventional Radiologist or Urologist
  • Radiology Technologist
  • Nursing Staff
  • Anesthesiologist (if general anesthesia is used)

Risks and Complications

  • Infection
  • Bleeding
  • Injury to the ureter or nearby organs
  • Discomfort or pain at the incision site
  • Rarely, allergic reaction to contrast material used in imaging

Benefits

  • Relieves urinary obstruction
  • Reduces infection risk
  • Improves kidney function
  • Usually, benefits are realized within a few days after the procedure.

Recovery

  • Monitoring in recovery room for several hours post-procedure.
  • Pain management with prescribed medications.
  • Instructions for site care and activity restrictions (e.g., avoid heavy lifting for a few days).
  • Follow-up appointments to check stent position and kidney function.

Alternatives

  • External urinary drainage (nephrostomy tube)
  • Open surgery to remove or replace the stent
  • Shockwave lithotripsy for stone removal
  • Each alternative has distinct pros and cons involving recovery time, efficacy, and patient suitability.

Patient Experience

  • The patient may feel pressure or mild discomfort during the procedure.
  • Post-procedure pain is typically managed with oral painkillers.
  • Mild discomfort at the incision site, which resolves within a few days.
  • Clearer urine flow and relief of urinary symptoms typically within a few days.

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