Cystotomy, with insertion of ureteral catheter or stent (separate procedure)
CPT4 code
Name of the Procedure:
Cystotomy with Insertion of Ureteral Catheter or Stent (Separate Procedure)
Summary
A cystotomy with insertion of a ureteral catheter or stent involves making an incision in the bladder to place a catheter or stent into the ureter. This helps alleviate urinary obstructions and allows urine to flow more freely from the kidney to the bladder.
Purpose
This procedure primarily addresses urinary obstructions caused by conditions such as kidney stones, tumors, or ureteral strictures. The goal is to restore the normal flow of urine, reduce pain, and prevent kidney damage.
Indications
- Severe kidney stones
- Ureteral strictures or blockages
- Tumors obstructing the urinary tract
- Persistent urinary tract infections
- Hydronephrosis (swelling of the kidney due to urine build-up)
Preparation
- Fasting for 6-8 hours before the procedure.
- Adjusting medications as directed by the healthcare provider.
- Undergoing imaging studies like ultrasounds or CT scans to assess the urinary tract.
- Completing blood and urine tests to ensure patient readiness.
Procedure Description
- Anesthesia: General or regional anesthesia is administered.
- Incision: A surgical incision is made in the lower abdomen to access the bladder.
- Bladder Access: A cut is made in the bladder (cystotomy) to expose the ureteral opening.
- Catheter/Stent Insertion: A catheter or stent is carefully guided through the ureter to ensure unobstructed urine flow.
- Closure: The bladder and abdominal incisions are closed with sutures.
Duration
The procedure typically takes about 1-2 hours.
Setting
This procedure is generally performed in a hospital operating room or a specialized surgical center.
Personnel
- Surgeon (typically a urologist)
- Anesthesiologist
- Surgical nurses
- Scrub technicians
Risks and Complications
- Infection
- Bleeding
- Injury to the bladder or ureter
- Urine leakage from the bladder
- Anesthesia-related complications
- Stent migration
Benefits
- Relief from urinary obstruction and associated symptoms
- Preservation of kidney function
- Reduction in pain and discomfort
- Improved overall urinary health
Recovery
- Hospital stay for 1-3 days post-procedure.
- Pain management with prescribed medications.
- Avoid strenuous activities for several weeks.
- Follow-up appointments for stent/catheter removal or replacement.
- Hydration to promote healing and prevent urinary infections.
Alternatives
- Extracorporeal Shock Wave Lithotripsy (ESWL) for kidney stones
- Percutaneous nephrolithotomy (PCNL)
- Ureteroscopy
- Conservative management with medications
Pros of Alternatives: Less invasive, shorter recovery time. Cons of Alternatives: May not be suitable for all types of obstructions or severity levels.
Patient Experience
During the procedure, patients will be under anesthesia and will not feel any discomfort. Post-operatively, there may be some pain and tenderness at the incision site, which can be managed with pain relief medications. Most patients will notice an improvement in symptoms immediately, but full recovery may take several weeks. It is crucial to follow medical advice for a smooth recovery.