CPT® Code 50125

1. Indications

The procedure of pyelotomy with drainage and pyelostomy is indicated for various conditions affecting the renal pelvis. These may include:

• Obstruction: Conditions that cause blockage of urine flow from the kidney to the ureter, which may lead to hydronephrosis or kidney damage.
• Infection: Severe infections in the renal pelvis that require drainage to prevent further complications.
• Trauma: Injuries to the kidney or renal pelvis that necessitate surgical intervention for repair or drainage.
• Calculi: The presence of kidney stones that may need to be removed or managed through drainage.

2. Procedure

The procedure of pyelotomy with drainage and pyelostomy involves several critical steps:

• Step 1: A skin incision is made over the kidney to access the renal pelvis. This incision is carefully planned to minimize damage to surrounding tissues.
• Step 2: Gerota's fascia, which encases the kidney, is incised, and the perirenal fat is dissected to expose the kidney adequately. This step is crucial for gaining access to the renal structures.
• Step 3: Blood vessels in the area are identified and controlled by placing a loop around each vessel. This step is essential to prevent excessive bleeding during the procedure.
• Step 4: The kidney and ureter are exposed and visually examined to assess for any abnormalities or conditions that may require intervention.
• Step 5: The ureter is traced upward to the ureteropelvic junction (UPJ), and the renal pelvis is located. This step ensures that the surgeon is working in the correct anatomical area.
• Step 6: The posterior aspect of the renal pelvis is exposed and incised. This incision allows for direct access to the renal pelvis for further exploration or treatment.
• Step 7: A pyelostomy tube is placed into the renal pelvis to facilitate the drainage of urine. This tube is critical for managing urine flow postoperatively.
• Step 8: A purse-string suture is placed around the pyelostomy tube to secure it to the renal pelvis, ensuring that the tube remains in position and functions effectively.
• Step 9: The surgical wound is closed in layers around the pyelostomy tube, which helps to protect the incision site and maintain the integrity of the surrounding tissues.
• Step 10: Finally, a pyelostomy bag is attached to the tube to collect urine, allowing for proper management of urine output following the procedure.

3. Post-Procedure

After the pyelotomy with drainage and pyelostomy, patients typically require monitoring for any signs of complications, such as infection or bleeding. The pyelostomy bag must be regularly checked and emptied to ensure proper urine drainage. Patients may also need to follow specific care instructions for the surgical site to promote healing and prevent infection. Follow-up appointments are essential to assess the effectiveness of the procedure and to determine if any further interventions are necessary.