Laparoscopic pyeloplasty

NICE interventional procedures guidance [IPG46] Published date:

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The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on laparoscopic pyeloplasty.

  • Description

    If the transition from the renal pelvis to the ureter is narrow, the urine will not drain easily and backs up causing dilatation of the collecting system proximal (behind) to that point and enlargement of the renal pelvis. This dilatation of the collecting system is referred to as hydronephrosis. UPJ obstruction is usually congenital, but may also be acquired (i.e. secondary to other disease processes or previous instrumentation).

    A pyeloplasty is a surgical procedure that is indicated for a ureteropelvic junction (UPJ) obstruction. The UPJ is the portion of the collection system that connects the renal pelvis (the larger collecting portion of the kidney that is funnel shaped and tapers down to the ureter) to the ureter. The standard intervention for ureteropelvic junction obstruction is open pyeloplasty.

    Many individuals with a UPJ obstruction do not realize they have this condition until later in life, when the poorly flowing urine becomes infected, or they begin developing symptoms such as pain.

    Although different types of pyeloplasty operations have been described, the ultimate goal is to remove the narrowed portion of the UPJ, refashion the renal pelvis, and attach it to the ureter in a way to allow for easy drainage of urine down the ureter. There are different ways to approach the kidney to perform the operation. These include via a flank incision, subcostal (under the rib) incision, transabdominal approach, or even sometimes through an incision in the back.

     

     

  • OPCS4.6 Code(s)

    M10.2 Endoscopic pyeloplasty

    or

    M05.1 Open pyeloplasty

    Y75.2 Laparoscopic approach to abdominal cavity NEC

    Note:Both coding solutions have been given as historically both have been used for laparoscopic pyeloplasty.

    The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS.   The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided.  www.connectingforhealth.co.uk/clinicalcoding

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