Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; existing access
CPT4 code
Name of the Procedure:
Injection Procedure for Antegrade Nephrostogram and/or Ureterogram
Summary
This procedure involves injecting contrast dye into an existing nephrostomy tube to obtain detailed X-ray images of the kidneys and ureters. It helps diagnose urinary tract obstructions or check the condition of urinary stents. The procedure involves imaging guidance, usually with ultrasound and fluoroscopy.
Purpose
- Medical Condition: Dilated or obstructed urinary tract.
- Goals: To diagnose blockages, leaks, or other abnormalities in the upper urinary tract; to assess the function and position of urinary stents.
Indications
- Symptoms such as flank pain, recurrent urinary tract infections, or hematuria (blood in urine).
- Conditions like hydronephrosis, ureteral strictures, or suspected urinary leak.
- Patients with pre-existing nephrostomy tubes needing diagnostic evaluation.
Preparation
- Pre-procedure Instructions: Nil per oral (NPO) for a few hours; adjust medications as advised by the doctor.
- Diagnostic Tests: Recent blood tests to check kidney function; prior imaging studies for baseline comparison.
Procedure Description
- Initial Setup: Patient is positioned on the imaging table.
- Sterilization: The area around the nephrostomy tube is cleaned.
- Contrast Injection: Contrast dye is injected through the nephrostomy tube.
- Imaging: Continuous X-ray images (fluoroscopy) or periodic ultrasound checks are performed.
- Completion: Images are reviewed to ensure quality and accuracy.
Tools: Nephrostomy kit, contrast dye, ultrasound machine, fluoroscopy equipment. Anesthesia: Usually none, but local anesthesia if necessary for patient comfort.
Duration
Typically takes around 30 to 60 minutes.
Setting
Performed in a radiology department, hospital, or specialized outpatient clinic.
Personnel
- Interventional Radiologist
- Radiologic Technologist
- Nurse or Medical Assistant
Risks and Complications
- Common Risks: Mild bleeding, infection at the injection site, discomfort.
- Rare Complications: Allergic reaction to contrast dye, significant bleeding, injury to the urinary tract.
Benefits
- Expected Benefits: Accurate diagnosis of urinary tract conditions; assessment of stent functionality.
- Timeline: Results are usually available immediately or shortly after the procedure.
Recovery
- Post-procedure Care: Monitor for signs of infection or complications.
- Recovery Time: Generally minimal; most patients resume normal activities within a few hours.
- Follow-Up: Appointment with the referring doctor to discuss the results.
Alternatives
- Other Options: Retrograde pyelogram, CT urogram, or MRI urogram.
- Pros and Cons: Less invasive procedures may offer limited diagnostic detail; more invasive alternatives may provide additional information but carry higher risks.
Patient Experience
- During the Procedure: Mild discomfort during contrast injection; minimal pain.
- After the Procedure: Possible temporary soreness at the injection site; pain relief medications if necessary.
- Comfort Measures: Local anesthesia or sedatives as needed.
This detailed markdown text should help patients understand the injection procedure for an antegrade nephrostogram and/or ureterogram and what they can expect before, during, and after the process.