50694 Placement of ureteral stent, 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, without sepa

Name of the Procedure:

Placement of Ureteral Stent, Percutaneous (including diagnostic nephrostogram and/or ureterogram when performed, using imaging guidance such as ultrasound and/or fluoroscopy, with all associated radiological supervision and interpretation; new access, without separate nephrostomy tube placement)

Summary

This procedure involves placing a thin, flexible tube called a stent into the ureter (the duct that carries urine from the kidney to the bladder) to keep it open. The procedure is performed through the skin using imaging technology for guidance, such as ultrasound or fluoroscopy.

Purpose

The primary purpose of placing a ureteral stent is to ensure urine flows from the kidney to the bladder when there's a blockage or narrowing (stricture) of the ureter. It helps relieve pain and prevent damage to the kidney caused by urine backflow.

Indications

• Kidney stones causing blockage in the ureter
• Ureteral strictures or narrowings
• Tumors pressing on or involving the ureter
• Prior to or following surgery to ensure ureteral patency
• Infections where drainage is needed

Preparation

• Patients may need to fast for several hours before the procedure.
• Blood tests and imaging studies, like a CT scan, may be required to plan the procedure.
• Adjustments to medications, particularly blood thinners, as instructed by the healthcare provider.

Procedure Description

1. The patient is typically given local anesthesia and possibly sedation to minimize discomfort.
2. Using ultrasound or fluoroscopy, the doctor inserts a needle through the skin into the kidney.
3. A guidewire is then passed through the needle into the ureter.
4. The stent is placed over the guidewire and advanced into position within the ureter.
5. Diagnostic nephrostogram and/or ureterogram may be performed to confirm the placement of the stent.
6. The stent remains in place to keep the ureter open, and the guidewire and needle are removed.

Duration

The procedure generally takes about 1 to 2 hours.

Setting

This procedure is performed in a hospital, typically in an interventional radiology suite or an operating room.

Personnel

• Interventional radiologist or urologist
• Nursing staff
• Radiology technician
• Anesthesiologist or nurse anesthetist (if sedation or anesthesia is used)

Risks and Complications

• Infection
• Bleeding
• Injury to the kidney or ureter
• Stent migration or blockage
• Pain or discomfort
• Allergic reactions to contrast material used in imaging

Benefits

• Relief from pain and discomfort caused by blocked urine flow
• Prevention of kidney damage
• Improved kidney function
• Overall enhanced quality of life

Recovery

• Patients typically stay in the hospital for a few hours to overnight for observation.
• Pain management with prescribed medications.
• Drink plenty of fluids to stay hydrated.
• Follow-up appointments are necessary to monitor the stent and its effects.

Alternatives

• Conservative management with medications (for small stones)
• Ureteroscopy and laser lithotripsy (to remove stones endoscopically)
• Open or laparoscopic surgery (for significant blockages or strictures)

Patient Experience

During the procedure, patients may feel some pressure or discomfort at the needle insertion site. Afterward, there may be minor pain or cramping, which can be managed with medications. Most patients can return to normal activities within a few days, with instructions to avoid heavy lifting or strenuous exercise for a short period. Regular follow-up is essential to monitor stent function and eventual removal.