Wiki large 3 cm stone burden with the bladder of the entire distal curl encases in stone.

[carol52]

Hello, I am in desperate need of some help with this extensive case of an incrusted bladder stent that the Dr. attempted to manipulate.
This was for a planned dual approach for a retained rt ureteral stent that was completely encased the distal curl measuring around 2-3 cm
Bladder:
-Combination of laser lithotripsy and manual lithotripsy
-transected stent at ureteral orifice. attempted to manipulate unable to.
-catheter placed.
Kidney:
PCNL- performed via existing access
-entire 2-2.5cm proximal curl was encased in stone, extensive laser lithotripsy performed, again transected stent at curl.
-Stent was only able to manipulate a very small amount. the entire stent passing into the UPJ remained encased with stone on the outside surface/
-able to retract around 4 cm of stent before stent remained impacted.
-Elected to place a second antegrade stent to slowly dilate the ureter... this will require a secondary procedure. at another time.

Dr. 1 st began with lithotripsy of the bladder stone usingg alligator graspers this was crushed and graspers were removed. no a 270 holiman laser was placed i through the ureteral catheter. I then performed an extensive cystolitholapxy of this 3cm stone.
Dr. was then able to sever the stent in multiple locations.
Still was not able to move the proximal curl.
now was comforted to use the percutaneous nephrolithotomy position.
This is an extensive procedure..
Would anyone be able to help with this...
Thanks,
Carol

 

[daniel]

Tough case, I'd look at CPT 50557 + 50561 + 50693 + 52318. tempted to use 50080 in place of 50557/50561. But I think this works.


50557 + 50561 + 50693
PCNL- performed via existing access
-entire 2-2.5cm proximal curl was encased in stone, extensive laser lithotripsy performed, again transected stent at curl.
-Stent was only able to manipulate a very small amount. the entire stent passing into the UPJ remained encased with stone on the outside surface/
-able to retract around 4 cm of stent before stent remained impacted.
-Elected to place a second antegrade stent to slowly dilate the ureter... this will require a secondary procedure. at another time.

52318
Dr. 1 st began with lithotripsy of the bladder stone usingg alligator graspers this was crushed and graspers were removed. no a 270 holiman laser was placed i through the ureteral catheter. I then performed an extensive cystolitholapxy of this 3cm stone.
Dr. was then able to sever the stent in multiple locations.
Still was not able to move the proximal curl.
now was comforted to use the percutaneous nephrolithotomy position.
This is an extensive procedure