CPT® Code 50526

1. Indications

The closure of nephrovisceral fistula, as described by CPT® Code 50526, is indicated in the following situations:

• Renal Stones The presence of renal stones can lead to the formation of a fistulous tract between the kidney and another organ, necessitating surgical intervention.
• Tuberculosis Renal tuberculosis may cause the development of a fistula, requiring closure to restore normal anatomical function.
• Injury from Percutaneous Procedures Accidental injury during procedures such as percutaneous nephrolithotomy can result in a nephrovisceral fistula that requires surgical repair.
• Lithotripsy Complications Complications arising from lithotripsy, a procedure used to break down kidney stones, may also lead to the formation of a fistulous tract.

2. Procedure

The procedure for the closure of a nephrovisceral fistula involves several critical steps:

• Step 1: Surgical Exposure The first step involves making an incision to expose the kidney and ureter. This surgical access is essential for visualizing the fistulous tract and performing the necessary repairs.
• Step 2: Catheter Insertion A catheter is then inserted into the ureter. This catheterization is crucial for the next step, as it allows for the introduction of a radiopaque substance.
• Step 3: Radiopaque Substance Injection A radiopaque contrast agent is injected through the catheter. This imaging technique helps to clearly delineate the fistulous tract, allowing the surgeon to trace its path accurately.
• Step 4: Tracing the Fistula The surgeon follows the fistulous tract down to its entry point into the involved organ, such as the colon. This step is vital for ensuring that the entire fistula is addressed during the procedure.
• Step 5: Ligation and Division Once the entry point is located, the fistula is carefully suture ligated and divided. This step effectively closes the abnormal connection between the kidney and the other organ.
• Step 6: Organ Repair After the fistula is divided, the involved organ is repaired as necessary to restore its function and integrity.
• Step 7: Closure of the Kidney Finally, the origin of the fistula within the kidney is closed to prevent any recurrence of the fistulous tract.

3. Post-Procedure

Post-procedure care following the closure of a nephrovisceral fistula typically involves monitoring for any complications, such as infection or leakage from the surgical site. Patients may require pain management and should be observed for signs of proper healing. Follow-up imaging may be necessary to ensure that the fistula has been successfully closed and that there are no residual issues. The recovery period can vary depending on the individual patient's health and the complexity of the procedure, but patients are generally advised to avoid strenuous activities during the initial recovery phase.