CPT® Code 52356

Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, Gibbons or double-J type)

CPT® Code 52356 refers to a specific medical procedure known as cystourethroscopy with ureteroscopy and/or pyeloscopy, which includes the use of lithotripsy and the insertion of an indwelling ureteral stent, such as a Gibbons or double-J type. This procedure is primarily performed to address urinary tract obstructions caused by calculi (stones) located in the ureters or renal pelvis. The process begins with the cleansing of the urethra using an antiseptic solution to minimize the risk of infection. A cystoscope, which can be either rigid or flexible, is then introduced through the urethra and into the bladder. To enhance visualization of the bladder wall, sterile saline may be instilled into the bladder. Once the bladder is inspected, the ureters are catheterized to facilitate access to the stones. A guidewire is carefully advanced through the cystoscope into the ureter, reaching the site of the calculus. Following this, a ureteroscope is advanced over the guidewire to the calculus site, where lithotripsy is employed to fragment the stone. This fragmentation can be achieved using either ultrasonic or electrohydraulic techniques, with the respective probe being advanced through the ureteroscope to generate shock waves that break the calculus into smaller pieces. After the stone is fragmented, a catheter is advanced over the guidewire to assist in flushing out the calculus fragments from the ureter and/or renal pelvis. The ureteroscope is then reintroduced to examine the renal pelvis and ureter before the placement of a stent. The stent is positioned in the ureter to ensure proper drainage and is left in place after the guidewire is removed. Finally, the cystoscope is used once more to inspect the bladder and confirm the correct positioning of the stent's distal tail before the procedure is concluded with the removal of the cystoscope. This comprehensive approach not only addresses the immediate issue of stone obstruction but also facilitates recovery and prevents future complications.