DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left hydronephrosis and pelvic mass.
POSTOPERATIVE DIAGNOSIS: Left hydronephrosis and pelvic mass with bladder mucosal irregularity.
OPERATION PERFORMED: Cystoscopy, bladder biopsy with fulguration, bilateral retrograde pyelograms, and bilateral ureteral stent placement.
ANESTHESIA: General.
INDICATION FOR OPERATION: This is a (XX)-year-old Hispanic female with large pelvic mass and left hydronephrosis.
DESCRIPTION OF OPERATION: After successful general anesthesia was obtained, the patient was placed in lithotomy position, and the abdominal area was prepped and draped in the usual manner. Cystoscopy was performed using a 21-French cystoscope with both 30 and 70 degrees oblique lenses. The urethra appeared to be normal. The bladder showed some slight irregularity of the dome region with significant impression in that region, which made the bladder appear almost like a crescent beneath the pelvic mass. Ureteral orifices were normally located. It was difficult to see good efflux from either side. There was grade 2/4 trabeculation of the bladder.
Right and left retrograde pyelography was performed, which showed a normal collecting system on the right side with some lateral deviation of the left distal ureter. There appeared to be mass effect in the pelvis on the preliminary film. There was no bowel in that region. The left retrograde pyelogram was very difficult to view due to what appeared to be an obstruction distal to the ureteral orifice. It was difficult to even get the cone tip catheter in the ureteral orifice, and the dye that was injected mostly went immediately back into the bladder, but there did seem to be some encasement of the distal ureter.
A 0.038 Glidewire was passed on both sides. Two stents were placed on the left, one was 26 cm 6 French that seemed a little bit short and the second one was 30 cm 6 French double pigtail catheter. The stent on the right side was 30 cm 6 French also. This appeared to be necessary because of the lateral displacement of the ureters and possible stretching of the ureter by the pelvic mass. Bladder was emptied after cauterization of the proximal bladder biopsy. Bimanual exam showed a very large pelvic mass, which was somewhat mobile. It was located mostly in midline, about 13 x 15 cm. The bladder was then emptied. The patient tolerated the procedure well and was brought to the recovery room with stable vital signs.
