Cystourethroscopy with insertion of ureteral guide wire through kidney to establish a percutaneous nephrostomy, retrograde
CPT4 code
Name of the Procedure:
Cystourethroscopy with Insertion of Ureteral Guide Wire Through Kidney to Establish a Percutaneous Nephrostomy, Retrograde
Summary:
This procedure involves using a special camera (cystoscope) to look inside the bladder and urethra. A guide wire is then inserted through the urinary system up to the kidney. This wire helps establish a nephrostomy, a small tube that drains urine from the kidney to an external bag.
Purpose:
This procedure is performed to drain urine directly from the kidney when there is a blockage that prevents normal urination. It helps relieve pressure and prevent damage to the kidneys.
Indications:
- Severe urinary tract obstruction
- Kidney stones blocking urine flow
- Hydronephrosis (swelling of the kidney due to urine build-up)
- Certain cancers blocking the urinary tract
- Failure of other less invasive treatments
Preparation:
- Fasting for at least 6 hours before the procedure
- Adjustment or discontinuation of certain medications such as blood thinners
- Pre-procedure imaging tests like an ultrasound or CT scan
- Blood tests to check kidney function and blood clotting levels
Procedure Description:
- Anesthesia: General or regional anesthesia to ensure the patient is comfortable and pain-free.
- Cystourethroscopy: A cystoscope is inserted through the urethra into the bladder.
- Guide Wire Insertion: The guide wire is passed through the urinary system up to the kidney.
- Nephrostomy Establishment: Using the guide wire, a nephrostomy catheter is placed in the kidney to facilitate urine drainage.
- Imaging Guidance: Fluoroscopy or ultrasound may be used for precise placement.
- Final Checks: Confirmation of catheter placement and functionality.
Duration:
The procedure typically takes about 1 to 2 hours.
Setting:
This procedure is generally performed in a hospital operating room or a specialized outpatient surgical center.
Personnel:
- Urologist or interventional radiologist (lead surgeon)
- Surgical nurses
- Anesthesiologist
- Radiologic technologist
Risks and Complications:
- Infection
- Bleeding
- Injury to surrounding organs
- Displacement or blockage of the nephrostomy tube
- Rarely, reactions to anesthesia
Benefits:
- Immediate relief from kidney pain due to obstruction
- Prevention of further kidney damage
- Improved kidney function
- Reduction of infection risk
Recovery:
- Post-procedure observation in recovery room
- Hospital stay of 1-2 days may be required
- Pain management with prescribed medications
- Instructions for nephrostomy tube care
- Follow-up appointments to monitor kidney function and tube placement
Alternatives:
- Ureteral stent placement: A tube inside the ureter to keep it open
- Extracorporeal shock wave lithotripsy (ESWL): Non-invasive treatment for kidney stones
- Open or laparoscopic surgery to remove the obstruction
- Pros and Cons: Less invasive options may have shorter recovery times but may not be as effective in severe cases. Surgery offers a more permanent solution but with longer recovery.
Patient Experience:
- Patients may feel groggy post-anesthesia
- Mild discomfort at the nephrostomy tube site
- Managing the nephrostomy bag can take some adjustment but usually becomes routine
- Pain management and antibiotics to prevent infection will be provided
- Gradual return to normal activities as healing progresses
This procedure aims to relieve kidney obstruction effectively, enhancing patient comfort and kidney health.