PREOPERATIVE DIAGNOSIS: Rectal cancer with right ureteral involvement.
POSTOPERATIVE DIAGNOSES:
1. Rectal cancer with right ureteral involvement.
2. Right distal ureteral stricture.
PROCEDURES PERFORMED:
1. Cystoscopy.
2. Right retrograde pyelogram.
3. Right ureteral stent change.
SURGEON: John Doe, MD
ANESTHESIA: General inhalational.
FINDINGS: Right distal ureteral stricture.
SPECIMENS: Ureteral stent.
DRAINS: A 6-French x 26 cm right double-J ureteral stent.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
DISPOSITION: Stable.
INDICATIONS FOR PROCEDURE: The patient is a (XX)-year-old Hispanic male with rectal cancer status post extensive pelvic and abdominal surgery. The cancer involved the right ureter, and we performed right ureteral repair six to eight weeks ago. The patient apparently has an indwelling ureteral stent and presents for stent removal versus change. Risks and benefits of the procedure were explained in detail to the patient, including bleeding, infection, damage to the urethra, bladder, ureters, kidneys, failure to diagnose and treat all disease, recurrence of disease, and possible need for further procedures. The patient expressed understanding and wished to proceed with cystoscopy, right retrograde pyelogram, and right ureteral stent change.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room and after adequate anesthesia was placed in the dorsal lithotomy position on the OR table. His genital and perineal regions were prepped and draped in a sterile fashion. The 21-French cystoscope was manipulated through the patient’s urethra, which appeared normal into the bladder. There was moderate prostatic enlargement. The stent was seen effluxing from the right ureteral orifice, and no other bladder lesions were seen. The stent was grasped with a flexible grasper and removed to the level of the urethral meatus where a guidewire was placed through the stent and this passed easily up the right collecting system under fluoroscopic guidance coiled in the right renal pelvis. The stent was then removed.
We then cannulated the right ureteral orifice with a cone-tip catheter and injected dilute contrast, which revealed no filling defects. There was a 3 cm narrowed area at the level of the ureteral repair with some proximal dilation of the ureter and renal pelvis. This was consistent with a ureteral stricture; therefore, we decided to place a fresh stent. It is likely the patient’s ureter will be managed with indwelling ureteral stent and periodic changes. We then placed a fresh 6-French x 26 cm double-J ureteral stent via Seldinger technique in the right collecting system under fluoroscopic guidance without difficulty.
We removed the wire with a stent in good position. We drained the bladder and removed the scope. The patient tolerated the procedure well. There were no complications. He was awakened and transported to the postanesthesia care unit in stable condition.
