CPT® Code 50135

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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 indicated in complicated cases, such as when a patient has undergone previous kidney surgery or has congenital kidney abnormalities. These abnormalities may include conditions like parenchymal disease, congenital obstruction of the ureteropelvic junction (UPJ), which can lead to hydronephrosis, or polycystic kidney disease. The surgical approach begins with a skin incision over the kidney, followed by the incision of Gerota's fascia and dissection of the perirenal fat to expose the kidney and ureter. The renal pelvis is then accessed for further exploration, which may involve examining for disease, placing a pyelostomy tube for urine drainage, or removing calculi (stones) if present. The complexity of the procedure is underscored by the need for careful management of blood vessels and the potential for additional interventions based on the patient's specific anatomical and pathological conditions.