CPT® Code 50750

1. Indications

Ureterocalycostomy is performed for specific medical conditions that necessitate the surgical intervention to restore normal urinary flow. The following indications are explicitly associated with this procedure:

• Ureteropelvic Junction (UPJ) Obstruction - A blockage at the junction where the ureter meets the renal pelvis, which can lead to hydronephrosis and impaired kidney function.
• Long Proximal Ureteral Stricture - A significant narrowing of the ureter that can obstruct urine flow, often resulting from previous surgeries, trauma, or congenital anomalies.
• Severe Fibrosis or Scarring of the Renal Pelvis - Conditions that cause extensive scarring in the renal pelvis, making traditional surgical options like ureteropyelostomy less viable.

2. Procedure

The ureterocalycostomy procedure involves several critical steps to ensure successful anastomosis between the ureter and the renal calyx. The following procedural steps are outlined:

• Step 1: Exposure and Mobilization of the Ureter - The surgeon begins by carefully exposing and mobilizing the ureter, ensuring that the surrounding periureteral tissue is preserved to maintain blood supply and function. This step is crucial for minimizing complications during the procedure.
• Step 2: Division of the Ureter - The ureter is then divided just distal to the narrowed region, allowing access to the proximal ureteral stump, which is subsequently ligated to prevent urine leakage.
• Step 3: Exposure of the Kidney - The kidney is exposed and mobilized to facilitate access to the lower pole calyx. This step may involve resecting the parenchyma over the lower pole to adequately visualize and prepare the site for anastomosis.
• Step 4: Resection of Diseased Tissue - Any remaining fibrotic or diseased tissue in the area is excised to ensure a healthy connection between the ureter and the calyx.
• Step 5: Spatulation of the Proximal Ureter - The proximal ureter is spatulated, which involves widening the ureteral end to facilitate a better fit for the anastomosis.
• Step 6: Placement of a Stent - A stent is placed within the ureter to support the anastomosis and ensure proper urine flow during the healing process.
• Step 7: Anastomosis Creation - The ureterocalyceal anastomosis is performed over the stent, connecting the ureter to the renal calyx securely.

3. Post-Procedure

After the ureterocalycostomy procedure, patients typically require careful monitoring and follow-up care to ensure proper healing and function of the anastomosis. Post-procedure care may include managing any pain or discomfort, monitoring for signs of infection, and ensuring that the stent remains patent. Patients may also need imaging studies to assess the success of the anastomosis and the overall function of the urinary system. Recovery time can vary based on individual patient factors and the complexity of the procedure, but close follow-up with the healthcare provider is essential to address any complications that may arise.