Radical prostatectomy was done 2 days previously. I need help with coding this, 2 days later. Any ideas?
The bladder neck was then examined. Clot and surrounding fluid was suctioned. The anastomosis was subsequently taken down sharply using monopolar scissors. Before taking down the posterior Polysorb stitch flexible cystoscopy was attempted to see if the left ureteral orifice could be identified which was difficult. The cystoscope was then removed. The anastomosis was then completely taken down and good efflux of urine was noted bilaterally. It was also noted that the left ureteral orifice was closer to the anastomosis than the right. Given this the decision was made to place a new left ureteral stent intracorporeally. Next, a sensor guidewire was advanced into the left ureter up into the kidney. Over this a 6 Fr by 26 cm stent was then advanced. Good reflux was noted again with the stent in place.
Prior to starting the anastomosis, the prostatic bed was inspected and appeared hemostatic. The anterior rectum was closely inspected, and there was no visible evidence of any injury or laceration or ischemia or excessive bleeding.
Bladder neck tailoring was required using a 2-0 V-Loc suture in a posterior tennis racquet fashion. Next, a single 2-0 vicryl suture was utilized to perform a posterior stitch to approximate the urethral stump with the bladder neck. Perineal pressure was applied to push out the urethral stump. Next, a double-armed 2-0 V-loc suture was then brought into the field and placed into the 6-o'clock posterior location of the bladder neck. The needles were then passed into their corresponding location in the posterior urethral stump. The foley catheter was reinserted to aid in aligning the anastomotic sutures. The anastomosis was then performed in a running fashion proceeding from posterior towards the 12-o'clock anterior location.
The bladder neck was then examined. Clot and surrounding fluid was suctioned. The anastomosis was subsequently taken down sharply using monopolar scissors. Before taking down the posterior Polysorb stitch flexible cystoscopy was attempted to see if the left ureteral orifice could be identified which was difficult. The cystoscope was then removed. The anastomosis was then completely taken down and good efflux of urine was noted bilaterally. It was also noted that the left ureteral orifice was closer to the anastomosis than the right. Given this the decision was made to place a new left ureteral stent intracorporeally. Next, a sensor guidewire was advanced into the left ureter up into the kidney. Over this a 6 Fr by 26 cm stent was then advanced. Good reflux was noted again with the stent in place.
Prior to starting the anastomosis, the prostatic bed was inspected and appeared hemostatic. The anterior rectum was closely inspected, and there was no visible evidence of any injury or laceration or ischemia or excessive bleeding.
Bladder neck tailoring was required using a 2-0 V-Loc suture in a posterior tennis racquet fashion. Next, a single 2-0 vicryl suture was utilized to perform a posterior stitch to approximate the urethral stump with the bladder neck. Perineal pressure was applied to push out the urethral stump. Next, a double-armed 2-0 V-loc suture was then brought into the field and placed into the 6-o'clock posterior location of the bladder neck. The needles were then passed into their corresponding location in the posterior urethral stump. The foley catheter was reinserted to aid in aligning the anastomotic sutures. The anastomosis was then performed in a running fashion proceeding from posterior towards the 12-o'clock anterior location.