lcole7465
Expert
PREOPERATIVE DIAGNOSIS: Renal calculus - 3 total measuring 2.1 x 1.7 cm renal pelvis, 1.1 x 1.3 cm lower pole, and approximately 8 mm upper pole
*
POSTOPERATIVE DIAGNOSIS: Same
*
PROCEDURES PERFORMED:
1. Left sided percutaneous nephrolithotomy for stone greater than 2 cm.
2. Antegrade nephrostogram.
3. Nephroureteral catheter placement.
4. Dilatation of nephrostomy tube tract
5. Laser lithotripsy of upper pole stone
*
ANESTHESIA: Gen et**
*
COMPLICATIONS: None.
*
DRAINS: A 26 French left Malecot with nephroureteral extension., Foley catheter
*
SPECIMEN: renal calculus
*
ESTIMATED BLOOD LOSS: Less than 10 mL.
*
INDICATION FOR PROCEDURE:
Patient is here for percutaneous nephrolithotomy procedure. She previously had several prior percutaneous nephrolithotomies. She presented with recurrent stone. Renal scan showed 30% function on the kidney. She presents now for repeat procedure After the procedure, risks, benefits, and alternatives were explained to the patient she elected to proceed. Informed consent was obtained.
*
DETAILS OF PROCEDURE:
Patient was brought back to the operating suite and placed in the prone position on the operative table. Patient was appropriately positioned. Patient was prepped and draped in a sterile fashion. Earlier today patient had had an occlusion balloon catheter placed with lower pole access per interventional radiology. We made an incision at the site of the wire. We passed a Lieberman dilator over the wire and then a 2nd wire backing up the Lieberman. We then pushed the NephroMax occlusion balloon over the wire. When it was within the kidney we inflated it to a pressure of 18-20 and maintained it there while the sheath was advanced under fluoroscopy over this to the level of the stone. The balloon was then taken down and removed. We then advanced the rigid nephroscope into the sheath. We could see the collecting system and could see stone in the lower pole.. We began by using the LilthoClast primarily on ultrasound and were able to break up the stones. Some pieces were pulled out and sent for analysis. We continued and found the rest of the stones which were also broken up with the LilthoClast and some pieces were pulled out. We then advanced into the renal pelvis in treated that stone as well in a similar fashion. When complete under fluoroscopy the upper pole stone was the only remaining 1. We placed a flexible cystoscope into the upper pole. With some angulation and a retrograde pyelogram we could outline where the stone was and enter that calyx. We then used a holmium laser fiber to start to dust that stone until it was small enough that we could then place a basket around it and pulled back to the sheath. It would not come into the sheath and we replaced the nephroscope and removed the stone . We then re-examined the kidney with the flexible scope. There were no other stones seen under fluoroscopy order direct vision. The balloon occlusion catheter was removed under fluoroscopy.. We then passed the 26 French Malecot with a nephroureteral extension through the sheath. We shot an antegrade nephrostogram and there was no extravasation of contrast. Malecot was in good position The sheath was removed and Malecot was sutured into place with a U stitch and placed to drainage. The procedure was terminated. The patient was awoken, extubated and transferred to PACU in stable condition.
I'm coming up with: 50081-LT, 50395, 52353
Thanks
This looks like it was performed earlier.
Pre-op Diagnosis: RENAL CALCULI LEFT
*
Post-op Diagnosis: Same
*
Procedure : Procedure(s):
CYSTOSCOPY WITH INSERTION BALLOON OCCLUSION CATHETER left
*
Indications: Patient has several large left kidney stones and presents for a balloon occlusion catheter with anticipation percutaneous nephrolithotomy later today
*
Details of Procedure: after informed consent was obtained he was brought to the operating room. After induction of mac anesthesia we placed her in dorsal lithotomy. Genitals were prepped draped usual fashion. She received IV antibiotics. Rigid cystoscope was placed. Bladder was inspected which appeared normal. The left ureter orifice was identified. We placed a 0.035 inch angled Glidewire and under fluoroscopy advanced past the renal pelvic stone. Over this we positioned a balloon occlusion catheter. The scope was withdrawn and a Foley catheter placed to gravity. The balloon was left deflated on the occlusion catheter. She was then sent to interventional radiology for percutaneous access
*
CPT: 52005 - LT
*
POSTOPERATIVE DIAGNOSIS: Same
*
PROCEDURES PERFORMED:
1. Left sided percutaneous nephrolithotomy for stone greater than 2 cm.
2. Antegrade nephrostogram.
3. Nephroureteral catheter placement.
4. Dilatation of nephrostomy tube tract
5. Laser lithotripsy of upper pole stone
*
ANESTHESIA: Gen et**
*
COMPLICATIONS: None.
*
DRAINS: A 26 French left Malecot with nephroureteral extension., Foley catheter
*
SPECIMEN: renal calculus
*
ESTIMATED BLOOD LOSS: Less than 10 mL.
*
INDICATION FOR PROCEDURE:
Patient is here for percutaneous nephrolithotomy procedure. She previously had several prior percutaneous nephrolithotomies. She presented with recurrent stone. Renal scan showed 30% function on the kidney. She presents now for repeat procedure After the procedure, risks, benefits, and alternatives were explained to the patient she elected to proceed. Informed consent was obtained.
*
DETAILS OF PROCEDURE:
Patient was brought back to the operating suite and placed in the prone position on the operative table. Patient was appropriately positioned. Patient was prepped and draped in a sterile fashion. Earlier today patient had had an occlusion balloon catheter placed with lower pole access per interventional radiology. We made an incision at the site of the wire. We passed a Lieberman dilator over the wire and then a 2nd wire backing up the Lieberman. We then pushed the NephroMax occlusion balloon over the wire. When it was within the kidney we inflated it to a pressure of 18-20 and maintained it there while the sheath was advanced under fluoroscopy over this to the level of the stone. The balloon was then taken down and removed. We then advanced the rigid nephroscope into the sheath. We could see the collecting system and could see stone in the lower pole.. We began by using the LilthoClast primarily on ultrasound and were able to break up the stones. Some pieces were pulled out and sent for analysis. We continued and found the rest of the stones which were also broken up with the LilthoClast and some pieces were pulled out. We then advanced into the renal pelvis in treated that stone as well in a similar fashion. When complete under fluoroscopy the upper pole stone was the only remaining 1. We placed a flexible cystoscope into the upper pole. With some angulation and a retrograde pyelogram we could outline where the stone was and enter that calyx. We then used a holmium laser fiber to start to dust that stone until it was small enough that we could then place a basket around it and pulled back to the sheath. It would not come into the sheath and we replaced the nephroscope and removed the stone . We then re-examined the kidney with the flexible scope. There were no other stones seen under fluoroscopy order direct vision. The balloon occlusion catheter was removed under fluoroscopy.. We then passed the 26 French Malecot with a nephroureteral extension through the sheath. We shot an antegrade nephrostogram and there was no extravasation of contrast. Malecot was in good position The sheath was removed and Malecot was sutured into place with a U stitch and placed to drainage. The procedure was terminated. The patient was awoken, extubated and transferred to PACU in stable condition.
I'm coming up with: 50081-LT, 50395, 52353
Thanks
This looks like it was performed earlier.
Pre-op Diagnosis: RENAL CALCULI LEFT
*
Post-op Diagnosis: Same
*
Procedure : Procedure(s):
CYSTOSCOPY WITH INSERTION BALLOON OCCLUSION CATHETER left
*
Indications: Patient has several large left kidney stones and presents for a balloon occlusion catheter with anticipation percutaneous nephrolithotomy later today
*
Details of Procedure: after informed consent was obtained he was brought to the operating room. After induction of mac anesthesia we placed her in dorsal lithotomy. Genitals were prepped draped usual fashion. She received IV antibiotics. Rigid cystoscope was placed. Bladder was inspected which appeared normal. The left ureter orifice was identified. We placed a 0.035 inch angled Glidewire and under fluoroscopy advanced past the renal pelvic stone. Over this we positioned a balloon occlusion catheter. The scope was withdrawn and a Foley catheter placed to gravity. The balloon was left deflated on the occlusion catheter. She was then sent to interventional radiology for percutaneous access
*
CPT: 52005 - LT