Wiki Ureterotomy??

[Miko24]

When I entered the operating room the patient was in the supine position. A laparotomy incision had been made previously by the Surgeon He proceeded to show me the left ureter and a defect at the dome of the bladder. The patient had undergone a colon resection and creation of a colostomy. I scrubbed in at this point. The bladder was inspected. There was some trauma noted to the peritoneal surface of the bladder just to the left of midline. There was no obvious mucosal injury. The Surgeon also showed me the left ureter. The distal left ureter was close to a staple line from the colon resection. I inspected this area grossly and did not see any obvious ureteral injury. The left ureter could be visualized crossing over the left iliac artery. There was no hydronephrosis. There was no obvious urine accumulating in the wound. I did sharply dissect the ureter down to the distal aspect where it appeared that the ureter was well away from the suture line. I did not dissect all the way down to the bladder itself.

I turned my attention to the bladder at this point. A portion of the peritoneum covering the dome of the bladder on the left side appears to have been resected. The detrusor appears to be intact without obvious injury there of. The bladder was then filled with 240 cc of normal saline. The area is inspected closely. With the bladder filled I did not see any leakage of saline. Nor did I visualize any injury to the detrusor or bladder mucosa. I was convinced at this point that there was no obvious bladder injury. The Foley catheter was replaced to gravity drainage. The Surgeon will plan to place a pelvic drain and we will monitor the outputs over the next 24-48 hours. This is the end of my portion of the procedure.

 

[haraml7]

It sounds like, from the information given, that the dissection of the ureter down to the distal aspect away from the suture line, was something that was done to protect the ureter from future injury. I don't see that an incision was made INTO the ureter. So i am thinking that the Ureterotomy would not be correct. Did the provider lysis around the ureter to get it away from the staple line. I would say this is a ureterolysis?

 

[liqgold2@aol.com]

I would suggest the following coding for your clinical scenario:
50600-52 for the exploration of the ureter and bladder. There was no ureterotomy dictated.