# Cystoscopy, bilateral retrograde pyelogram, and pressure cystogram



## bailsb (Apr 23, 2013)

Is this just 52005, 74420-26 or am I overthinking this?  Help is greatly appreciated.

Cystoscope was advanced into the urinary bladder under direct visualization.  There was a mild urethral stricture, which was dilated with the scope.  The urinary bladder was systematically inspected.  It was mildly trabeculated.  The ureteral orifices were noted  in the normal anatomic positions.  There was mild cystitis.  No bladder tumors or frank areas of severe cystitis or anything resembling a fistulous tract.  The urethra was inspected and again no areas of obvious fistula.  Next, the 6-French open-ended catheter was advanced through the scope and into the left ureteral orifice.  A left retrograde pyelogram was performed.  This was followed up to the kidney in real time.  There was a sharp nephrogram phase, which subsequently drained.  The ureter appeared normal without fistulous tract.  The kidney apppeared normal without evidence of extravasation.  The exact same procedure was performed on the right with the same result.  Next, the scope was removed and a 16-French foley catheter was inserted and I performed a pressure cystogram with approx 500 mL of saline mixed with Conray.  Fluoroscpy was performed along with oblique films.  I did not see any evidence of fistulous tract or extravasation of contrast.  A Foley cath was placed to bag drainage.  Patient awakened and tranfered to recovery room in stable condition. 

Thank you,
Brendan Bailey, CPC


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