Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Transurethral Removal of Obstruction from Ureter


Related Terms

  • Transurethral Ureteropyeloscopy
  • Ureteral Stone-basketing

Specialists

  • Urologist

Comorbid Conditions

Factors Influencing Duration

The presence of any complications and the individual's reaction to the procedure will determine the length of disability. Recurrence of kidney stones may necessitate repeat procedures.

Medical Codes

ICD-9-CM:
56.0 - Transurethral Removal of Obstruction of Ureter and Renal Pelvis; Removal of: Blood Clot From Ureter or Renal Pelvis without Incision, Calculus from Ureter or Renal Pelvis without Incision, Foreign Body From Ureter or Renal Pelvis without Incision

Overview

The transurethral removal of an obstruction from the ureter (transurethral ureteropyeloscopy) involves insertion into the urethral opening of a flexible, lighted, fiberoptic instrument followed by advancement through the urethra and bladder into the ureter in order to remove stones (calculi) that have become lodged in it. The procedure is most often performed to remove calculi from the tubular passageway (ureter) that leads from the kidney to the urinary bladder.

Stone formation in the kidneys (urolithiasis) occurs when excess stone-forming mineral salts such as calcium (80% of all stones), uric acid, or struvite present in supersaturated urine are not cleared by the kidneys and urinary tract and begin to accumulate and crystallize. Stones can form as a result of excess calcium in the urine (hypercalciuria), certain cancers (multiple myelomas, lung cancer, and metastatic bone cancer), overactivity of the parathyroid glands (hyperparathyroidism) or a rare congenital condition (cystinuria) resulting in stones composed of the amino acid cysteine. Stones can also form in people who do not consume enough fluids (chronic dehydration) or in those who are immobile for prolonged periods. Kidney stones occur more frequently in people with a high salt intake, in those people who work in more sedentary occupations (e.g., white-collar workers, educators, physicians) or who live in hot climates, and in individuals with a family history of kidney stones. Certain medications (some antihypertensives and antacids) are also associated with kidney stone formation because of their effect on calcium absorption and excretion.

More than 70% of kidney stones smaller than 4 millimeters in size are passed spontaneously through the urinary tract, whereas only 15% of stones larger than 6 millimeters do so. These larger stones may become lodged in either ureter (ureteral stones). Endoscopic procedures are often required to remove stones that do not pass spontaneously. The most common method employed to remove kidney stones involves transurethral procedures. Extracorporeal shock wave lithotripsy (ESWL) may be performed to break up a stone, allowing its spontaneous passage or easier removal using a transurethral approach. Stones in the ureter may also be removed by open surgery.

Source: Medical Disability Advisor



Reason for Procedure

Severe pain and discomfort are associated with a stone obstructing the ureter. The stone itself interrupts the excretion of urine from the kidneys, and its removal immediately relieves the pain and prevents the backflow of urine and subsequent kidney damage.

Source: Medical Disability Advisor



How Procedure is Performed

Transurethral removal of stones may be done in the doctor's office using a local anesthetic or, more frequently, in a hospital with a general or regional anesthetic. A computed tomography (CT) scan or x-ray of the kidney, ureter, and bladder (KUB) is obtained immediately prior to the procedure to determine the exact location of the stone. A lubricated, flexible telescopic instrument (ureteropyeloscope, uteroscope, cytoscope, or scope) is inserted into the urethra and advanced into the bladder. A guide wire is inserted into the ureteral opening (orifice). Using direct visualization through x-ray (fluoroscopy) projected onto a monitor, the guide wire is advanced into position adjacent to the obstructing stone. A balloon dilator may be used to gently inflate (dilate) the walls of the ureter. The ureteroscope is passed over the guide wire, and small instruments are inserted through the scope. The stone is grasped by a basket-like instrument and delivered through the scope to the outside (often called stone basketing). Larger stones may be broken apart first by using a laser or high-frequency sound waves (ultrasound). Contrast media may be administered intravenously to allow better fluoroscopic visualization of the stone. A temporary small tubular wire cage (stent) may be inserted at the termination of the procedure to aid in any healing of the ureter, keep the ureter open (patent), and prevent scarring with subsequent obstruction.

When the stone is lodged in the upper third of the ureter, it may be pushed into the kidney, where it can be treated using extracorporeal shock wave lithotripsy (ESWL) or retrieved by percutaneous nephrolithotomy.

Source: Medical Disability Advisor



Prognosis

The predicted outcome of transurethral removal of a ureteral obstruction is the removal of the obstruction, that is, in most cases, removal of a kidney stone. Its removal will prevent kidney damage associated with increased pressure on kidney tissue (renal parenchyma) caused by the backup of urine in the kidney (hydronephrosis). In addition, if urine has already backed up, removal of the ureteral obstruction will allow thorough drainage of the kidney, and if performed before permanent damage has occurred, allow recovery of kidney function. In some individuals, kidney stones may recur.

Source: Medical Disability Advisor



Complications

Complications may include infection, perforation of the ureter, bladder, or urethra, and bleeding. Some individuals may have allergic reactions to contrast media used in the procedure. Ureteral damage from the stone or the procedure itself can result in subsequent scarring with obstruction of the ureteral opening (lumen).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restrictions or accommodations may not be necessary. Time off from work may be needed for treatment such as ESWL. The presence of kidney stones in the ureter is often associated with marked pain and discomfort, necessitating hospitalization and use of narcotics to control symptoms.

Risk: Once recovery is complete and the individual has returned to his or her job duties, there is no risk to working following this procedure unless the individual works in a high temperature environment. Recurrence may be reduced by addressing any underlying condition or diagnosis that may have contributed to stone formation. Individuals with recurrent renal calculi that migrate into the ureter(s) may benefit from staying adequately hydrated and participating in regular exercise.

Capacity: Capacity is unaffected following this procedure once the individual has recovered and any narcotic medications have been discontinued.

Tolerance: Tolerance is typically not a concern following this procedure unless the affected individual experiences recurrent kidney stone formation, obstructive urethral scarring, or permanent kidney damage.

Source: Medical Disability Advisor



Maximum Medical Improvement

30 days.

Source: Medical Disability Advisor



References

Cited

Taneja, Samir S. Complications of Urologic Surgery. 4th ed. Saunders Elsevier, 2010.

Source: Medical Disability Advisor






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