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