CPT® Code 50976

1. Indications

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

• Abnormal Tissue: The procedure is performed to investigate and treat abnormal tissue growths within the ureter.
• Foreign Bodies: Ureteral endoscopy is indicated for the removal of foreign bodies, such as stents or calculi, that may obstruct the ureter.
• Calculi: The presence of ureteral stones (calculi) that require removal or treatment is a common indication for this procedure.
• Diagnostic Purposes: The procedure may be performed to obtain tissue samples for biopsy to diagnose potential malignancies or other pathological conditions.

2. Procedure

The procedure of ureteral endoscopy through ureterotomy involves several key steps, each critical for successful outcomes.

• Step 1: Incision Creation The procedure begins with the creation of a small incision in the ureter. This incision allows for direct access to the ureteral lumen, facilitating the introduction of the ureteroscope.
• Step 2: Ureteroscope Introduction Once the incision is made, the ureteroscope is carefully introduced into the ureter. This instrument is equipped with a camera and light source, enabling the physician to visualize the interior of the ureter.
• Step 3: Inspection of the Ureter The physician inspects the ureter for any abnormalities, including abnormal tissue, foreign bodies, or calculi. This visual examination is crucial for determining the appropriate course of action.
• Step 4: Irrigation and Instillation The ureter may be irrigated with normal saline to clear any debris and improve visibility. Additionally, diagnostic or therapeutic solutions may be instilled into the ureter as needed.
• Step 5: Ureteropyelography (if applicable) If indicated, contrast material may be injected to perform ureteropyelography, which is a separate radiologic service that provides detailed imaging of the ureter and renal pelvis.
• Step 6: Biopsy (if applicable) If a biopsy is warranted, biopsy forceps are introduced through the ureteroscope to obtain one or more tissue samples for pathological examination.
• Step 7: Fulguration and/or Incision The physician may perform fulguration to destroy abnormal tissue using an electrocautery device, laser, or cryoprobe. Alternatively, an incision may be made to remove or treat the abnormal tissue directly.
• Step 8: Foreign Body Removal (if applicable) If a foreign body or calculus is identified, a grasping device or basket is advanced through the working channel of the ureteroscope to capture and remove the obstruction.
• Step 9: 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 is clear of any remaining obstructions.

3. Post-Procedure

Post-procedure care following ureteral endoscopy through ureterotomy typically involves monitoring the patient for any immediate complications, such as bleeding or infection. Patients may be advised to maintain hydration to facilitate urine flow and help flush out any residual debris. Follow-up appointments may be scheduled to assess recovery and to discuss any further treatment options if necessary. It is important for patients to report any unusual symptoms, such as severe pain, fever, or changes in urination, to their healthcare provider promptly. Overall, the expected recovery time is generally short, allowing patients to resume normal activities relatively quickly, depending on the extent of the procedure performed.