CPT® Code 50740

Ureteropyelostomy is a surgical procedure that involves the creation of an anastomosis, or connection, between the upper part of the ureter and the lower part of the renal pelvis. This procedure is specifically indicated for conditions such as ureteropelvic junction (UPJ) obstruction or a long proximal ureteral stricture, which can impede the normal flow of urine from the kidney to the bladder. In contrast to ureteropyelostomy, ureterocalycostomy is a related procedure that connects the ureter to the calyces, which are the cup-like structures in the kidney, at a point above the lower aspect of the renal pelvis. Ureterocalycostomy is typically performed when the renal pelvis is significantly fibrosed or scarred, making it unsuitable for direct anastomosis. During ureteropyelostomy, the surgeon carefully exposes and mobilizes the ureter while preserving the surrounding periureteral tissue. The procedure involves dividing the ureter just distal to the narrowed area, ligating the proximal ureteral stump, and mobilizing the kidney. The lower aspect of the renal pelvis is then excised above the obstructed segment, and the healthy proximal ureter is spatulated to facilitate the anastomosis. A stent is placed to ensure proper drainage during the healing process, and the ureteropelvic anastomosis is constructed over this stent, with additional reinforcement provided by perinephric fat or omentum to support the surgical connection.