DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Acute obstruction of the left upper ureter.
OPERATION PERFORMED: Cystoscopy with ureteroscopic laser lithotripsy and basket extraction of a left ureteral calculus and placement of a double-J stent.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
OPERATIVE FINDINGS: The KUB demonstrated a radiopaque calculus that was in the longitudinal portion of the upper ureter that was 3 cm in length and about 1 cm in width. The estimate on the stone on the CT was 0.9 cm x 0.56 cm. By the time we saw this, the patient was asleep and had been receiving platelets, as he does have leukemia and platelet dysfunction. We felt we should go ahead and at least put up a stent and, if possible, get rid of the sone, albeit that it was a very, very large stone burden. The outcome was excellent. The urethra, prostatic urethra, and bladder were normal. The stone was obvious, and it was hard to get a wire past the stone, but we eventually did so by placement of a Pollack catheter. It was fairly easy to get the ureteroscope up to the upper ureter and one could encounter the stone quite well. It did not bounce around and was relatively fixed in position, and so we were able to fragment it into multiple fragments, all of which we think are large enough to pass. When fluoroscopy was done at the end of this procedure, we did not see any calculus debris.
DESCRIPTION OF OPERATION: Under anesthesia, the patient was prepped and draped and given prophylactic antibiotics. The patient was given platelets at the request of his oncologist. A 21-French cystopanendoscope was passed through the urethra into the bladder, and with Foroblique right angle lenses, the above-mentioned findings were noted. We passed a wire into the left ureter. This would not go past the stone, as noted on fluoroscopy. We placed a Pollack catheter up to the stone, and with this help, the wire could go by the stone into the renal pelvis. We then balloon dilated the orifice of the left ureter up to 16 atmospheres with a balloon dilator. We removed that and placed a rigid ureteroscope, and we were able to negotiate this up to the stone without too much difficulty. We then used the Holmium laser and gradually chipped away at this stone until it was no longer intact, and the multiple pieces noted were relatively small and we thought that they would probably pass. We placed a basket up the ureter with an attempt to remove some of the calculus debris and did so. However, we thought most of it would pass. We then passed a 7 x 26 double-J stent and confirmed its location in the ureter. The patient tolerated this well and was discharged to the recovery room in satisfactory condition.
