# 52344 Bundles??



## RainyDaze (Aug 20, 2014)

Hi All,

My physician performed a ureteral dilation, lithotripsy and a stent placement.  It looks like 52344 bundles into 52356, you can use a 59 to break the bundle.  My question is what when is it acceptable to use the 59?  Is it only when performed on different sides???  Here is a description of his procedure.  Thanks for your help.


POSTOPERATIVE DIAGNOSIS: 
Large distal right ureteral stone with secondary hydronephrosis. 
Distal ureteral stricture preventing passage.

OPERATIVE PROCEDURE: Right ureteroscopy, ureteral dilatation of stricture, holmium laser lithotripsy, and double-J stent placement.

INTRAOPERATIVE FINDINGS: There were, in fact, 2 stones in the distal right ureter, 3 mm and 7 mm, unable to pass due to a discrete narrowing of the distal ureter, which required dilatation. The patient has smaller stones in the right kidney, which did not need to be treated at this time. Will check a 24-hour urine postoperatively.

OPERATIVE PROCEDURE: The patient underwent smooth induction of general anesthesia, after, SCD stockings placed, given IV antibiotics, placed in the dorsal lithotomy position, and prepped and draped in the usual sterile fashion. Cystoscopy showed a normal anterior and posterior urethra with some moderate obstruction from the lateral lobes of the prostate. Bladder appeared normal. Ureteral orifices were orthotopic. Right ureteral orifice intubated with a sensor guidewire into the renal pelvis. Semirigid ureteroscopy was successful passing the ureteral orifice; however, about 2-3 cm proximal from the ureteral orifice, there was a discrete narrowing consistent with a ureteral stricture, and I could see the stone just proximal to this stricture. This was gently dilated, allowing me to access the stones, which were treated with the holmium laser. These stones were brown and hard, consistent with a calcium oxalate monohydrate composition, requiring a higher energy level of more than 8000 kilojoules to break up these 2 stones with minimal urothelial trauma. A 6 French x 28 cm double-J stent was then passed over a guidewire, with good position confirmed on fluoroscopy. Bladder emptied, and the cystoscope removed. The patient tolerated the procedure quite well. The patient will follow up with me in 1-2 weeks for cystoscopy and stent removal.


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