suela923@aol.com
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Could someone explain the difference to me between an ureterography, 50684 and a nephrostogram, 50394? I thought ureterography meant the ureter was imaged and with a nephrostogram it would be the kidney/renal pelvis.
Nephrostogram with nephrostomy tube change
History: Status post removal of a proximal left ureteral stone. Nephrostomy tube still in place. Patient reports copious urine drainage into the nephrostomy to bag.
Technique: A timeout was performed. The indwelling nephrostomy tube was injected with contrast. This shows filling of the renal pelvis and ureter. Contrast is not seen flowing across the pelvic inlet and into the pelvic ureter. Even placing the patient's feet down did not allow for flow into the bladder.
Exchange was then made for a Berenstein catheter. This was directed down the ureter and used to perform a distal ureterogram. There are several air bubbles. No stone fragments are seen. However, the distal several centimeters of the ureter are diffusely narrowed, likely the result of edema.
Patient's referring physician was then contacted. It was decided to leave the patient's percutaneous nephrostomy catheter in place for now. She will remain on external drainage.
IMPRESSION:
Probable edema of the distal ureter with resultant at least partial obstruction of the left kidney and high volume drainage from left nephrostomy catheter. Patient is scheduled to see Dr. R in one week. At that time I would recommend closing the stopcock and allowing the patient to drain internally. If she tolerates this, we have scheduled a followup appointment with her 2-3 days after her urology appointment to remove the catheter.
Thanks for any help in understanding the differences.
Sue
Nephrostogram with nephrostomy tube change
History: Status post removal of a proximal left ureteral stone. Nephrostomy tube still in place. Patient reports copious urine drainage into the nephrostomy to bag.
Technique: A timeout was performed. The indwelling nephrostomy tube was injected with contrast. This shows filling of the renal pelvis and ureter. Contrast is not seen flowing across the pelvic inlet and into the pelvic ureter. Even placing the patient's feet down did not allow for flow into the bladder.
Exchange was then made for a Berenstein catheter. This was directed down the ureter and used to perform a distal ureterogram. There are several air bubbles. No stone fragments are seen. However, the distal several centimeters of the ureter are diffusely narrowed, likely the result of edema.
Patient's referring physician was then contacted. It was decided to leave the patient's percutaneous nephrostomy catheter in place for now. She will remain on external drainage.
IMPRESSION:
Probable edema of the distal ureter with resultant at least partial obstruction of the left kidney and high volume drainage from left nephrostomy catheter. Patient is scheduled to see Dr. R in one week. At that time I would recommend closing the stopcock and allowing the patient to drain internally. If she tolerates this, we have scheduled a followup appointment with her 2-3 days after her urology appointment to remove the catheter.
Thanks for any help in understanding the differences.
Sue
