Operative Note

PROCEDURE: Left ureteroscopy and laser lithotripsy stage stenting with insertion of 4.7 French by 24 cm double J stent.

SUMMARY: This is a patient with a left ureteropelvic junction calculus who underwent previous stent placement and is undergoing ureteroscopy and laser lithotripsy. Following adequate general endotracheal anesthesia, the patient was prepped and draped in the usual sterile fashion. A 22 French rigid cystoscope was then placed into the ureter and advanced into the urinary bladder without difficulty. The previously placed left urinary stent was identified and was grasped with biopsy forceps and this was removed from the meatus. At the meatus, the stent was grasped and guidewire was placed up into the left renal pelvis. Next, the stent was removed. A dual lumen catheter was placed over the guidewire and a second guidewire was placed also within the renal pelvis. Next, the ureteral access sheath was placed over the guidewire and advance up into the proximal ureter. One of the wires and the obturator to the ureteral access sheath was then removed and the flexible ureteroscope was then advanced up the left ureter up into the renal pelvis. The previous proximal ureteropelvic junction stone was identified. This was an upper pole calix. 200 micron laser fiber was then used to fragment the stone into basketful sized fragments. Next, the stone basket was used to grasp the fragments and removed via ureteral access sheath.

Next, the following removal of the large stone fragments there was only a small amount of debris. Contrast was then placed within the left renal pelvis. The upper, middle, and lower pole calices were examined and no significant stone burn was identified. Next, the ureteroscope was brought to the level of the ureteral access sheath, and the scope and access sheath were brought out in combination to examine the remainder of the ureter. It was free of stone. Next, a 4.7 French by 24 cm double J stent was placed over the preexisting guidewire with initial good curl within the renal pelvis. The patient began to awaken and now it appears that the proximal end of the stent was within the lower pole calix with adequate curl. The distal end had good curl within the urinary bladder. The bladder was then drained, scope removed. The patient was extubated and taken to recovery in stable condition. The patient will follow up in approximately 1 week for stent removal. The patient was given a prescription for narcotic pain medication, Vicodin, as well as an antibiotic.

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