CPT® Code 50120

1. Indications

The pyelotomy procedure is indicated for various conditions affecting the renal pelvis. These may include:

• Exploration for Disease or Injury The primary indication for a pyelotomy is to explore the renal pelvis for any signs of pathological conditions or trauma that may affect kidney function.
• Suspected Obstruction A pyelotomy may be performed when there is a suspicion of obstruction in the urinary tract, particularly at the ureteropelvic junction.
• Presence of Calculi The procedure may be indicated if there is a need to investigate or remove kidney stones that are lodged in the renal pelvis.

2. Procedure

The pyelotomy procedure involves several critical steps to ensure proper access and exploration of the renal pelvis. The steps are as follows:

• Step 1: Skin Incision The procedure begins with a skin incision made over the kidney to provide access to the renal area. This incision is carefully planned to minimize damage to surrounding tissues.
• Step 2: Incision of Gerota's Fascia After the skin incision, Gerota's fascia, which encases the kidney, is incised. This step is essential to expose the kidney and surrounding structures for further dissection.
• Step 3: Dissection of Perirenal Fat The perirenal fat is meticulously dissected to reveal the kidney and ureter. This dissection is performed with caution to avoid injury to blood vessels and other critical structures.
• Step 4: Identification and Control of Blood Vessels Once the kidney is exposed, blood vessels are identified and controlled by placing loops around each vessel. This step is crucial to prevent excessive bleeding during the procedure.
• Step 5: Exposure and Examination of the Kidney and Ureter The kidney and ureter are then fully exposed and visually examined for any abnormalities or signs of disease.
• Step 6: Tracing the Ureter to the UPJ The surgeon traces the ureter upward to the ureteropelvic junction (UPJ) to locate the renal pelvis accurately.
• Step 7: Incision of the Renal Pelvis Once the renal pelvis is located, the posterior aspect is incised to allow for exploration. This incision provides direct access to the renal pelvis for further evaluation.
• Step 8: Exploration of the Renal Pelvis In this final step, the renal pelvis is carefully explored for any signs of disease or injury, which may guide further treatment decisions.

3. Post-Procedure

After the pyelotomy procedure, careful post-operative care is essential for optimal recovery. Patients are typically monitored for any signs of complications, such as bleeding or infection. Pain management is provided as needed, and the surgical site is assessed for proper healing. Depending on the findings during the exploration, additional interventions may be required, such as the placement of a pyelostomy tube if drainage is necessary. Follow-up appointments are scheduled to evaluate the patient's recovery and to ensure that kidney function is restored and any underlying issues are addressed.