CPT® Code 50974

1. Indications

Ureteral endoscopy through ureterotomy is indicated for various conditions affecting the ureter. The following are the explicitly provided indications for this procedure:

• Abnormal Tissue The procedure is performed to investigate and obtain biopsies of abnormal tissue found within the ureter.
• Foreign Body Removal It is indicated when there is a need to locate and remove foreign bodies, such as stents or calculi, that may be obstructing the ureter.
• Ureteral Calculi The procedure is indicated for the diagnosis and treatment of ureteral stones that may cause pain or obstruction.
• Diagnostic Evaluation Ureteral endoscopy is utilized for diagnostic purposes, including ureteropyelography, to assess the urinary tract's condition.

2. Procedure

The procedure of ureteral endoscopy through ureterotomy involves several critical steps, each designed to ensure thorough examination and treatment of the ureter. The following procedural steps are outlined:

• Step 1: Ureterotomy An incision is made in the ureter to provide access for the ureteroscope. This step is crucial as it allows the physician to directly visualize the ureter's interior.
• Step 2: Introduction of Ureteroscope A ureteroscope is carefully introduced through the incision. This instrument is equipped with a camera and light, enabling the physician to inspect the ureter for any abnormalities.
• Step 3: Inspection and Irrigation The ureter is inspected for abnormal tissue, foreign bodies, or calculi. During this inspection, the ureter may be irrigated with normal saline or other diagnostic solutions to enhance visibility and facilitate the examination.
• Step 4: Biopsy If abnormal tissue is identified, biopsy forceps are inserted through the ureteroscope to obtain one or more tissue samples for pathological evaluation.
• Step 5: Additional Procedures Depending on the findings, additional procedures may be performed, such as fulguration or incision of abnormal tissue using electrocautery, laser, or cryoprobe techniques. This step aims to destroy any identified lesions.
• Step 6: Foreign Body Removal If a foreign body or calculus is located, a grasping device or basket is advanced through the ureteroscope to capture and remove the obstruction.
• Step 7: Final Inspection After the necessary interventions, the ureter is re-inspected to ensure that no injury has occurred during the procedure and that the ureter remains intact.

3. Post-Procedure

Post-procedure care following ureteral endoscopy through ureterotomy involves monitoring the patient for any complications and ensuring proper recovery. Patients may experience some discomfort or pain at the incision site, which can be managed with appropriate analgesics. It is essential to monitor for signs of infection or complications such as bleeding or urinary obstruction. Follow-up appointments may be scheduled to assess the healing process and review biopsy results if applicable. Patients are typically advised to maintain hydration and may be instructed on activity restrictions to promote recovery. The healthcare provider will provide specific post-operative care instructions tailored to the individual patient's needs.