# Transcather therapy, embolization left ureter



## claning (Sep 25, 2013)

Help! I would really love some direction on this report...37204/75894, 50690/74425, 50953, 52005 ??? am I close? sorry it's long...  carol

PROCEDURE: TRANSCATHER THERAPY, EMBOLIZATION LEFT URETER

INDICATIONS: contrast study of ileal conduit. is there 
extravasation of urine from left ureter to abscess cavity.

TECHNIQUE: The procedure was discussed with the patient 
and informed consent obtained. The patient was prepped and 
draped with usual sterile conditions. 

PROCEDURE: Initially a Foley catheter was placed in the 
ureterostomy in the right lower quadrant. The retrograde 
ileal loop study was performed showing a patent right 
ureter. Contrast did reflux into the left ureter with 2 
areas of extravasation demonstrated where the ureter 
crosses the left iliac stent and at the proximal ureter at 
the nephrectomy site. A 7 French guide sheath and was 
advanced into the ileal loop and position near the left 
ureteral connection. A 5 French catheter was then coaxially 
passed into the left ureter. Contrast injection 
demonstrated marked extravasation from the proximal left 
ureter and mild extravasation at perforation site where the 
ureter crosses the left iliac stent.

The catheter was advanced over guidewire into the proximal 
ureter and multiple embolization coils placed. Pledgets of 
Gelfoam were then injected within the wire mesh. The 
catheter was then brought down to just above the left iliac 
stent and multiple coils were placed spanning the site of 
extravasation. Additional pledgets of Gelfoam were injected 
into the wire mesh. This resulted in complete occlusion of 
the left ureter. The catheters were then removed and the 
patient transferred back to the floor in stable condition.

The procedure was tolerated well. There were no 
complications.

FLUOROSCOPY TIME: 48 MIN

CONCLUSION: Successful retrograde cannulation of the 
isolated left ureter. 2 areas of extravasation 
demonstrated. The left ureter was successfully embolized 
with embolization coils and Gelfoam.


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## claning (Oct 4, 2013)

*Anyone? help!*

Does anyone have any insights?


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## Kelly_Mayumi (Oct 12, 2013)

Hi Claning, what an interesting case!  I think you're on the right track with 37204 but I might use an unlisted urinary code and compare to the 37204?  
That my $0.02.


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