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Ureteral embolization or occlusion, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)

CPT4 code

Name of the Procedure:

Ureteral Embolization or Occlusion, Including Imaging Guidance (e.g., Ultrasound and/or Fluoroscopy), and All Associated Radiological Supervision and Interpretation

Summary

Ureteral embolization is a minimally invasive procedure used to block blood flow to the ureter, which is the tube carrying urine from the kidney to the bladder. Imaging guidance, such as ultrasound and fluoroscopy, aids the precise placement of materials to achieve this blockage.

Purpose

Ureteral embolization addresses medical conditions where obstructing the ureter is beneficial, such as severe urinary leakage or in preparation for surgical removal of a kidney. The primary goal is to control or prevent urine flow through the ureter, either temporarily or permanently.

Indications

Symptoms or conditions warranting this procedure include:

  • Severe ureteral injury or fistula
  • Persistent urinary leakage
  • Preparation for nephrectomy (kidney removal) Patient criteria include:
  • Inability to repair the ureter through other means
  • Need for palliative care in malignancy

Preparation

Pre-procedure instructions might include:

  • Fasting for 6-8 hours before the procedure
  • Adjusting current medications under doctor’s guidance, particularly blood thinners
  • Performing renal function tests and imaging studies

Procedure Description

  1. Pre-procedure Imaging: Ultrasound or fluoroscopy guides needle placement.
  2. Access: A catheter is inserted into the ureter through the bladder or via the kidney.
  3. Embolization: Materials like coils, plugs, or particles are injected to block the ureter.
  4. Verification: Imaging confirms the effective occlusion.
  5. Removal: The catheter is withdrawn, and the insertion site is closed.

Tools used include catheters, embolization materials, ultrasound, and fluoroscopy machines. Local anesthesia with or without conscious sedation is typically used.

Duration

The procedure usually takes 1-2 hours.

Setting

It is performed in a hospital or an outpatient interventional radiology suite.

Personnel

  • Interventional radiologist (primary operator)
  • Radiologic technologists
  • Nurses
  • Anesthesiologist or nurse anesthetist, if required

Risks and Complications

Common risks:

  • Pain or discomfort at the insertion site
  • Bruising or infection Rare risks:
  • Kidney damage
  • Migration of embolization material
  • Allergic reaction to contrast dye

Benefits

The procedure provides controlled urine flow, reducing leakage and preventing complications. Benefits are typically realized immediately post-procedure, with significant symptom relief.

Recovery

Post-procedure care may include:

  • Monitoring for several hours in a recovery area
  • Pain management with prescribed medications
  • Instructions to avoid strenuous activities for a few days
  • Follow-up imaging to ensure successful occlusion

Alternatives

  • Surgical repair of the ureter
  • Nephrostomy tube placement
  • Conservative management with medications Each alternative has its pros and cons regarding invasiveness, recovery time, and effectiveness.

Patient Experience

Patients may feel minor discomfort or pressure during catheter placement. Post-procedure, mild pain at the site is common but manageable with pain relievers. Most discomfort resolves within a few days, leading to significant symptom relief.

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