CPT® Code 50130

A pyelotomy is a surgical procedure that involves making an incision into the renal pelvis, which is the central cavity of the kidney responsible for collecting urine from the calyces. This procedure is typically performed to address issues such as the presence of calculi, or stones, within the renal pelvis. The renal pelvis serves as a conduit for urine, allowing it to drain into the ureter. During a pyelotomy, a skin incision is made over the kidney, followed by the incision of Gerota's fascia and dissection of the perirenal fat to access the kidney. Surgeons carefully identify and control blood vessels by encircling them with loops to prevent excessive bleeding. The kidney and ureter are then exposed for visual examination, allowing the surgeon to trace the ureter upward to the ureteropelvic junction (UPJ) and locate the renal pelvis. Once the posterior aspect of the renal pelvis is accessed, it is incised to facilitate exploration for any signs of disease or injury. In cases where a pyelostomy is required, a tube is placed into the renal pelvis to aid in urine drainage. The procedure may involve the removal of a single calculus using specialized stone forceps or, in cases of multiple small stones, a coagulum pyelolithotomy technique may be employed. This technique involves creating a clot that encapsulates the small stones, which is achieved by injecting thrombin and calcium chloride solution into the renal pelvis prior to incision. The formation of the clot allows for the effective removal of the stones during the procedure, ensuring that the renal pelvis is cleared of obstructions and functioning properly.