At first I was thinking 51710 and 52332-50 but it seems like more work was involved to control the bleeding of the SP tube site. Thoughts? Thanks!!
FINDINGS:
Mildly brisk venous bleeding from granulation tissue of suprapubic tube tract at the level of the fascia. Bilateral ureteral stents were exchanged. The removed stents appeared to have been patent.
DETAILS OF PROCEDURE:
The patient was taken to the operating room and positively identified as well as the site of surgery during a time-out. After adequate general anesthesia, he was prepped and draped in usual sterile fashion for suprapubic tube revision and cystoscopy. He was actively bleeding from his suprapubic tube site which was controlled with packing. An attempt was made fulgurating the suprapubic tube site after passing an open-ended catheter through this site into the bladder and withdrawing it out through the meatus cystoscopically. Unfortunately, I was unable to control the bleeding with fulguration through the suprapubic tube site. Therefore I created an incision approximately 2 cm above and below the suprapubic tube site and midline and taken down to the fascia. The fascia was opened in the midline where a distance of a cm superior and inferior to the suprapubic tube site. This gave access to the actual bleeding granulation tissue which was controlled with electrocautery. The suprapubic tube site was then packed with Telfa and attention was turned toward stent exchange. The cystoscope was then passed under direct vision into the patient's bladder. Anterior urethra was unremarkable. Prostatic urethra was not obstructing. His left ureteral stent was grasped and brought out through the urethral meatus with forceps. I did not feel the guidewire was passed through this stent into the renal stent under fluoroscopic guidance. Next the guidewire was backloaded through cystoscope and 6-French x 22 cm double-J stent was placed in standard fascia. This process was repeated on the right-hand side. Both stents appeared to have an excellent align with curl in the renal pelvis and bladder.
Packs were then removed from the suprapubic tube site and suprapubic tube passed adjacent to the open-ended catheter. Under direct vision, cystoscopically, the 16-French Foley catheter was placed at the suprapubic tube and inflated to 15 cc. There was no active bleeding within the bladder. The balloon was withdrawn up against the bladder wall. Following this, the open-ended catheter was removed. Due to gauze wrapped around, the Foley catheter was placed at the suprapubic tube at the level of the fascia that aided hemostasis. The fascia was closed with a figure-of-eight and simple interrupted 2-0 Vicryl above and below the catheter. Hemostasis was checked and noted to be excellent. The skin was closed with simple interrupted 2-0 nylon above and below suprapubic tube. The lower suture was used as a stay stitch to hold the Foley catheter in place. Sterile dressings were applied. All counts were correct. The patient tolerated the procedure well without complications. 20220730 AP
FINDINGS:
Mildly brisk venous bleeding from granulation tissue of suprapubic tube tract at the level of the fascia. Bilateral ureteral stents were exchanged. The removed stents appeared to have been patent.
DETAILS OF PROCEDURE:
The patient was taken to the operating room and positively identified as well as the site of surgery during a time-out. After adequate general anesthesia, he was prepped and draped in usual sterile fashion for suprapubic tube revision and cystoscopy. He was actively bleeding from his suprapubic tube site which was controlled with packing. An attempt was made fulgurating the suprapubic tube site after passing an open-ended catheter through this site into the bladder and withdrawing it out through the meatus cystoscopically. Unfortunately, I was unable to control the bleeding with fulguration through the suprapubic tube site. Therefore I created an incision approximately 2 cm above and below the suprapubic tube site and midline and taken down to the fascia. The fascia was opened in the midline where a distance of a cm superior and inferior to the suprapubic tube site. This gave access to the actual bleeding granulation tissue which was controlled with electrocautery. The suprapubic tube site was then packed with Telfa and attention was turned toward stent exchange. The cystoscope was then passed under direct vision into the patient's bladder. Anterior urethra was unremarkable. Prostatic urethra was not obstructing. His left ureteral stent was grasped and brought out through the urethral meatus with forceps. I did not feel the guidewire was passed through this stent into the renal stent under fluoroscopic guidance. Next the guidewire was backloaded through cystoscope and 6-French x 22 cm double-J stent was placed in standard fascia. This process was repeated on the right-hand side. Both stents appeared to have an excellent align with curl in the renal pelvis and bladder.
Packs were then removed from the suprapubic tube site and suprapubic tube passed adjacent to the open-ended catheter. Under direct vision, cystoscopically, the 16-French Foley catheter was placed at the suprapubic tube and inflated to 15 cc. There was no active bleeding within the bladder. The balloon was withdrawn up against the bladder wall. Following this, the open-ended catheter was removed. Due to gauze wrapped around, the Foley catheter was placed at the suprapubic tube at the level of the fascia that aided hemostasis. The fascia was closed with a figure-of-eight and simple interrupted 2-0 Vicryl above and below the catheter. Hemostasis was checked and noted to be excellent. The skin was closed with simple interrupted 2-0 nylon above and below suprapubic tube. The lower suture was used as a stay stitch to hold the Foley catheter in place. Sterile dressings were applied. All counts were correct. The patient tolerated the procedure well without complications. 20220730 AP