DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right flank pain.
POSTOPERATIVE DIAGNOSIS: Right flank pain with hydronephrosis and ureteral stricture, status post transureteroureterostomy.
PROCEDURES PERFORMED:
1. Cystoscopy.
2. Left retrograde pyelography.
3. Left ureteroscopy with treatment of ureteral stricture.
4. Left double-J stent insertion into right kidney.
SURGEON: John Doe, MD
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed on the table in the dorsal lithotomy position and prepped and draped in the customary fashion. Cystoscopic examination was performed. The trigone was identified. The right ureteral orifice was absent. A mount of tissue overlying that area was identified. The left ureteral orifice was normal in position and shape and had clear efflux.
The left retrograde pyelogram was performed. Mild narrowing was noted at the junction of the middle and lower thirds of the left ureter. The right ureter was not visualized, although the patient was known to have transureteroureterostomy of the right ureter into the left ureter. Left ureteroscopic examination was performed. A stricture was noted in the left ureter and dilated. The anastomosis of the right ureter into the left ureter was visualized, and a guidewire was threaded through the ostomy into the right kidney. A Pollack catheter was threaded over the guidewire into the right kidney.
Retrograde pyelogram was performed showing marked hydronephrosis of the right kidney with a subsequent hydronephrotic drip from the right kidney. The distal right ureter went into the left ureter was then dilated and the double-J stent threaded over guide into the right renal pelvis and brought out through distal left ureter into the bladder. The patient tolerated the procedure well and was returned to the recovery room in satisfactory condition.
DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Bilateral hydronephrosis.
2. Bilateral renal calculi.
3. Right ureteral stricture.
POSTOPERATIVE DIAGNOSES:
1. Bilateral hydronephrosis.
2. Bilateral renal calculi.
3. Right ureteral stricture.
PROCEDURES PERFORMED:
1. Cystoscopy with right double-J stent removal.
2. Right retrograde pyelogram.
3. Treatment of right ureteral stricture.
4. Right double-J stent insertion.
5. Left double-J stent removal.
6. Left retrograde pyelogram.
7. Left double-J stent insertion.
8. Removal and reinsertion of left nephrostomy tube with left nephrostogram.
SURGEON: John Doe, MD
ANESTHESIA: General.
DESCRIPTION OF PROCEDURE: The patient was brought to the cystoscopy suite and placed on the table in the dorsal lithotomy position. The perineum and left flank were prepped and draped in the usual fashion. Cystoscopic examination was performed. The distal urethra was unremarkable. The prostatic urethra was nonobstructing. The bladder was entered. Cloudy urine was present, so the bladder was irrigated until clear.
The right double-J stent was then visualized, grasped and removed from the right ureteral orifice. A Pollack catheter could not be passed up the right ureter. Right ureteroscopic examination identified the right ureteral stricture, which was then dilated allowing further instrumentation. Pyelogram was performed identifying the renal pelvis and calyces.
A 6 French x 22 cm double-J stent was then threaded over a guidewire into the right renal pelvis and brought out into the bladder. The left double-J stent was then identified, grasped and removed. A retrograde pyelogram was performed identifying the lower pole and upper pole of the left kidney. Calculi were present. A guidewire was threaded into the upper pole of the left kidney and an 8.5 French x 26 cm double-J stent was threaded over the guidewire into the upper pole of the left kidney and brought out into the bladder.
The left nephrostomy tube was then removed, and a new nephrostomy tube placed into the lower pole of the left kidney. A left nephrostogram was performed showing the nephrostomy tube to be in good position. The patient tolerated the procedure well and was returned to the recovery room in satisfactory condition.
