Cystotomy/cystostomy/cystolitholapaxy

nabernhardt

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needing help please with this procedure. I got 52317 figured out. but not sure what else to use with it. 51102? thanks
The patient was placed in lithotomy and initially was administered IV sedation.
Flexible cystoscopy was performed using the Stryker 15 F flexible cystoscope. The scope was passed under direct vision using video. Prior to passing the scope, his artificial urinary sphincter was deactivated and the scope was then passed into the patient's bladder. I was able to see his small native bladder and then passed the scope further into his enterocystoplasty bladder. There was gross bleeding noted upon passage of the scope for some reason. I was never able to define where the bleeding was coming from throughout the whole case. However, the mucosa of the bladder was inflamed and friable. The bladder stone was surrounded by a blood clot. Because of the patient's artificial urinary sphincter, I elected to perform a cystotomy and gain access to the bladder suprapubically. This was done by distending the bladder with the flexible cystoscope in the bladder and identifying the site of the suprapubic insertion. A 2 cm incision was then made with an 11 blader after instilling 1% lidocaine. I then dissected down until the bladder was identified. I then used Metzenbaums to gain access to the bladder and then passed a Storz 27
F continuous flow sheath using the obturator. This was done while watching with the flexible cystoscope. Once this was then placed, I used the Storz lithotrite to break the stone into small enough pieces to irrigate. I then irrigated through the 27 F sheath. Visualization was difficult because of the hematuria but eventually all large fragments were removed. There were still some microscopic fragments remaining, however.
The irrigation proceeded until I got out as much stone fragments as I could and then I replaced the sheath with a 20 F Foley catheter for a suprapubic tube and inflated the balloon to 10 cc. The catheter irrigated light pink at the end of the procedure.
The flexible cystoscope was then removed. The artificial urinary sphincter was reactivated. Thecatheter was placed to gravity drainage.
 
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