CPT® Code 50525

1. Indications

The closure of a nephrovisceral fistula is indicated in the following situations:

• Renal Stones Fistulous tracts may develop as a complication of renal stones, necessitating surgical intervention to prevent further complications.
• Tuberculosis Renal tuberculosis can lead to the formation of fistulas, requiring closure to restore normal anatomy and function.
• Injury from Percutaneous Procedures Fistulas may occur as a result of injuries sustained during percutaneous interventions, which may require surgical repair.
• Lithotripsy Complications Complications from lithotripsy, a procedure used to break down kidney stones, can also lead to the formation of nephrovisceral fistulas.

2. Procedure

The procedure for closing a nephrovisceral fistula involves several critical steps:

• Step 1: Surgical Approach The surgeon begins by selecting an abdominal approach to access the kidney and the involved organ. This approach is essential for visualizing and manipulating the fistulous tract effectively.
• Step 2: Exposure of the Kidney and Ureter Once the abdominal cavity is accessed, the kidney and ureter are carefully exposed to allow for direct intervention on the fistula.
• Step 3: Catheter Insertion A catheter is inserted into the ureter to facilitate the identification of the fistulous tract. This step is crucial for ensuring accurate localization of the fistula.
• Step 4: Injection of Radiopaque Substance A radiopaque substance is injected through the catheter. This imaging agent helps to visualize the fistulous tract on imaging studies, allowing the surgeon to trace its path to the involved organ.
• Step 5: Identification and Division of the Fistula The surgeon follows the fistulous tract down to its entry point in the involved organ, such as the colon. Once located, the fistula is suture ligated and divided to separate the abnormal connection.
• Step 6: Repair of the Involved Organ After the fistula is divided, the surgeon repairs the involved organ to restore its integrity and function.
• Step 7: Closure of the Fistula Origin Finally, the origin of the fistula in the kidney is closed to prevent any further complications or recurrence of the fistulous tract.

3. Post-Procedure

Post-procedure care following the closure of a nephrovisceral fistula typically involves monitoring for any signs of complications, such as infection or leakage from the surgical site. Patients may require pain management and should be observed for any changes in urinary function. Follow-up imaging may be necessary to ensure that the fistula has been successfully closed and that the involved organ is healing properly. The recovery period may vary depending on the extent of the surgery and the patient's overall health status.