CPT® Code 50830

Urinary undiversion (eg, taking down of ureteroileal conduit, ureterosigmoidostomy or ureteroenterostomy with ureteroureterostomy or ureteroneocystostomy)

A urinary undiversion, also referred to as a take-down procedure, is a surgical intervention aimed at restoring the normal continuity of the urinary tract. This procedure is typically indicated for patients who have previously undergone a diversion of the urinary system due to injury to the ureter or bladder, necessitating a temporary alteration in the urinary pathway. It is also commonly performed in pediatric patients with specific urologic conditions that require a temporary diversion until a definitive surgical correction can be achieved or until the condition resolves naturally. The complexity of the procedure is influenced by the type of urinary diversion previously performed and the individual patient's anatomical considerations. During the surgery, the abdomen is incised along the midline, allowing access to the peritoneal cavity. The small bowel is carefully isolated and moved out of the surgical field to facilitate the procedure. Adhesions, which are bands of scar tissue that may have formed, are lysed to free up the anatomy for evaluation. The surgeon assesses the remaining proximal ureteral segments, the sites of any ureteral anastomosis, distal ureteral segments, the urinary bladder, and any existing ileal conduit. The goal of the procedure is to reconnect the ureters to restore normal urinary flow, which may involve mobilizing the renal pelvis to ensure proper reimplantation into the bladder. The procedure may also include the placement of stents to support the ureters during the healing process, and if an ileal conduit was previously used, it is carefully mobilized and reattached to the bladder. Overall, urinary undiversion is a critical procedure for patients requiring restoration of their urinary function after a diversion has been implemented.