Placement of nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, new access
CPT4 code
Name of the Procedure:
Placement of Nephroureteral Catheter, Percutaneous
Summary
This procedure involves placing a catheter into the kidney (nephrostomy) and ureter (ureterostomy) through a small skin incision. It often includes imaging tests like nephrostograms or ureterograms to guide the catheter placement and ensure it is in the correct position. This is done using imaging techniques like ultrasound and/or fluoroscopy.
Purpose
The procedure helps to manage conditions causing urinary obstruction or drainage issues in the kidneys or ureters. The goal is to alleviate blockages, allow for diagnostic imaging, and facilitate urinary drainage.
Indications
- Urinary obstructions due to stones, tumors, or scarring.
- Infection risk due to blocked urine flow.
- Kidney swelling (hydronephrosis) needing immediate drainage.
- Patients requiring diagnostic assessment of the upper urinary tract.
Preparation
- Fasting for several hours before the procedure.
- Possible medication adjustments as directed by your doctor.
- Pre-procedure blood tests and imaging studies such as ultrasound or CT scan for planning.
Procedure Description
- The patient is positioned, and the skin is cleaned and sterilized.
- Local anesthesia is administered to numb the area, sometimes with sedation.
- A small incision is made in the flank area.
- A needle is inserted into the kidney under imaging guidance.
- A guidewire is passed through the needle into the kidney and down the ureter.
- A catheter is threaded over the guidewire into the kidney and down the ureter.
- Imaging (nephrostogram or ureterogram) may be performed to confirm placement.
- The catheter is secured in place and connected to a drainage bag.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
This procedure is usually performed in a hospital's interventional radiology suite or operating room.
Personnel
- Interventional Radiologist or Urologist
- Radiologic Technologist
- Nurses
- An anesthesiologist or sedation nurse, if sedation is used
Risks and Complications
- Pain or discomfort at the insertion site
- Bleeding or hematoma formation
- Infection
- Injury to the kidney or other organs
- Catheter displacement or blockage
- Allergic reaction to contrast material (if used)
Benefits
- Relieves symptoms caused by urinary obstruction
- Reduces the risk of kidney damage and infections
- Provides diagnostic information
- Can be a temporary or long-term solution, depending on the underlying condition
Recovery
- Monitoring in a recovery area until effects of anesthesia or sedation wear off
- Instructions on catheter care and management
- Avoid heavy lifting or strenuous activities for a few days
- Follow-up appointments for catheter maintenance and monitoring
Alternatives
- Ureteral stent placement
- Surgical repair or bypass of the obstruction
- Observation and medical management if the condition is not severe
Each alternative has its pros and cons depending on the specific condition and patient health.
Patient Experience
- You may feel pressure or mild discomfort during the insertion of the catheter.
- Sedation will help to minimize discomfort.
- Post-procedure, you might experience soreness at the insertion site and will need to manage the external catheter and drainage bag.
- Pain relief medications will be provided if needed.
Detailed instructions on how to manage the catheter at home and when to seek medical advice for complications will be given.