CPT® Code 50770

1. Indications

Transureteroureterostomy is performed for specific medical conditions that necessitate the surgical intervention to restore normal urinary function. The following indications are explicitly recognized for this procedure:

• Ureteral Stenosis - A narrowing of the ureter that can impede the flow of urine.
• Ureteral Obstruction - A blockage in the ureter that prevents urine from passing through, which can lead to kidney damage.
• Ureteral Injury - Damage to the ureter that may occur due to trauma, surgical complications, or other medical conditions.

2. Procedure

The transureteroureterostomy procedure involves several critical steps to ensure successful anastomosis of the ureters. The following procedural steps are outlined:

• Step 1: Exposure and Evaluation - Both ureters are surgically exposed, allowing the surgeon to assess their mobility and length. This evaluation is crucial for determining the feasibility of the procedure and ensuring that adequate healthy ureteral tissue is available for the anastomosis.
• Step 2: Mobilization of the Diseased Ureter - The diseased ureter is carefully mobilized above the area of the affected segment, extending up to the ureteropelvic junction (UPJ). During this step, the surgeon takes care to preserve the surrounding periureteral tissues and blood supply to minimize complications and promote healing.
• Step 3: Creation of a Retroperitoneal Tunnel - A tunnel is created in the retroperitoneal space, which will facilitate the transposition of the healthy ureter across the midline to connect with the contralateral ureter.
• Step 4: Transection of the Diseased Ureter - The diseased segment of the ureter is transected above the affected area, allowing for the healthy segment to be brought into position for anastomosis.
• Step 5: Transposition of the Healthy Ureter - The proximal healthy segment of the ureter is transposed through the retroperitoneal tunnel to the opposite ureter, ensuring that it is adequately positioned for connection.
• Step 6: Mobilization of the Recipient Ureter - The recipient ureter is mobilized to facilitate the anastomosis with the transposed ureter, ensuring that both segments can be sutured together effectively.
• Step 7: Spatulation and Suturing - The transposed ureter is spatulated, which involves making an incision to widen it. This step is followed by suturing the transposed ureter to the recipient ureter, creating a secure connection that allows for the passage of urine.
• Step 8: Ureteral Stenting - Ureteral stenting may be performed as needed to support the anastomosis and ensure proper urine flow during the healing process.
• Step 9: Drain Placement and Closure - A drain is placed in the abdomen adjacent to the anastomosis site to prevent fluid accumulation. Finally, the surgical wound is closed in layers to promote healing and reduce the risk of infection.

3. Post-Procedure

After the transureteroureterostomy procedure, patients typically require monitoring for any complications related to the surgery. Post-procedure care may include managing pain, monitoring for signs of infection, and ensuring proper urinary function. The placement of a drain will help in the management of any fluid accumulation around the surgical site. Patients may also need follow-up imaging studies to assess the success of the anastomosis and the overall function of the urinary system. Recovery time can vary based on individual health factors and the extent of the surgery, but patients are generally advised to follow their healthcare provider's instructions for post-operative care to ensure optimal recovery.