CPT® Code 51060

1. Indications

The transvesical ureterolithotomy procedure is indicated for the following conditions:

• Ureteral Calculi Presence of stones in the ureter that cannot be removed through less invasive methods such as ureteroscopy or extracorporeal shock wave lithotripsy.
• Obstruction Situations where the stone causes a blockage in the urinary tract, leading to potential complications such as hydronephrosis or infection.
• Failed Conservative Treatment Cases where previous attempts to manage ureteral stones through conservative or minimally invasive techniques have been unsuccessful.

2. Procedure

The transvesical ureterolithotomy involves several critical procedural steps:

• Step 1: Incision A skin incision is made in the lower abdomen, specifically over the urinary bladder, to provide access for the procedure. This incision is carefully planned to minimize tissue damage and facilitate the subsequent steps.
• Step 2: Tissue Dissection The surgeon dissects through the abdominal layers down to the anterior rectus muscle sheath. This involves separating the rectus abdominus and pyramidalis muscles, which are retracted to expose the peritoneum.
• Step 3: Bladder Exposure Once the peritoneum is reflected, the urinary bladder is exposed. An incision is made in the bladder wall to allow access to the ureter.
• Step 4: Placement of Stay Sutures Two stay sutures are placed in the bladder wall, lateral to the planned incision site. These sutures are crucial as they help to tent the bladder, providing a stable area for further incision.
• Step 5: Incision in the Bladder A stab incision is made between the stay sutures in the tented portion of the bladder. This incision is then enlarged until the ureteral orifice becomes visible, allowing for access to the ureter.
• Step 6: Ureteral Access A second incision is made through the bladder wall near the ureter, enabling the surgeon to locate the calculus in the distal aspect of the ureter.
• Step 7: Stone Extraction The ureter is incised, and the calculus is extracted through the bladder. This step is critical for relieving the obstruction caused by the stone.
• Step 8: Closure of Incisions After the stone is removed, the ureteral incision is closed, followed by the closure of the proximal bladder incision. The anterior wall of the bladder is then closed, and finally, a layered closure of the abdominal incision is performed to ensure proper healing.

3. Post-Procedure

Post-procedure care for patients undergoing transvesical ureterolithotomy typically includes monitoring for any signs of complications such as infection or bleeding. Patients may require a catheter to facilitate urinary drainage while the bladder heals. Pain management is also an essential aspect of post-operative care, and patients are advised on activity restrictions to promote recovery. Follow-up appointments are necessary to assess healing and ensure that no further complications arise.