Bilateral Nephrostomy,Bilateral Ureteral stent
How to code this senario.
is this correct.
1. Bilateral Nephrostomy placement
2. Bilateral Ureteral stent placement.
With the patient in prone position, both flanks were prepped and
draped in the usual sterile manner and locally anesthetized with
1% lidocaine. Initially, under real time ultrasound imaging
guidance a left lower pole posterior calix was accessed with a
21-gauge needle. An ultrasound imaged was recorded for the
patient's record. Contrast was injected and a nephrostogram was
obtained, confirming the calyceal puncture. The site was then
dilated with a triaxial introducer set, and a been a 4-French
Berenstein catheter was advanced into the distal ureter. Contrast
is injected and multiple images were obtained. This demonstrates
severe hydroureteronephrosis. The ureter is occluded at the
region of the pelvic inlet.
Using a Berenstein catheter and an angled Glidewire, the occluded
ureter was successfully traversed, into the bladder. Over an
Amplatz wire the tract was dilated and an 8-French double-J
ureteral stent was deployed, positioned with the distal loop in
the bladder and the proximal loop coiled within the renal pelvis.
An 8-French nephrostomy catheter was left in place on the left as
Using similar technique on the right side, a right-sided 8-French
nephrostomy and 8-French 22 center long double-J ureteral stent
were placed. The only difference on the right is that two- stick
technique was used, as the first ultrasound-guided access was into
an infundibulum. The second fluoroscopy guided access was
directly into a posterior lower pole calix. On the right there
was only moderate hydronephrosis, and the right ureter occludes
higher up, in the lower abdomen.
At the end of the procedure both nephrostomy catheters were
sutured in place and connected to an external drainage bag and
sterile dressings were applied. The patient tolerated the
procedure well, left the department in stable condition.
Bilateral 8-French 22 cm long ureteral stents placed, as well as
bilateral 8-French nephrostomy catheters.