DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Ureteral stricture.
POSTOPERATIVE DIAGNOSIS: Ureteral stricture.
OPERATION PERFORMED:
1. Cystourethroscopy.
2. Right retrograde pyelogram.
3. Right ureteral stent exchange.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General.
COMPLICATIONS: None.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old gentleman who has undergone multiple kidney transplants in the past. He subsequently developed a ureteral stricture, which has failed repair. He has been treated with regular stent exchanges since that time.
DESCRIPTION OF OPERATION: After proper informed consent was obtained, the patient was brought to the cystoscopy suite and placed in the supine position. After successful induction of general anesthesia, the patient was repositioned in the dorsal lithotomy position. The patient’s genitalia and perineum were sterilely prepped and draped in the standard fashion.
A 21-French rigid cystourethroscope was inserted into the meatus and carefully navigated down the length of the urethra and into the bladder. The bladder was then drained. Once inside the bladder, the indwelling stent was identified. Flexible graspers were placed through the working port of the scope and were used to grasp the distal portion of the stent, which was then pulled through the meatus. A Glidewire was placed through the lumen of the stent and advanced proximally under fluoroscopic guidance. The old stent was then removed. A Pollack catheter was then placed over the wire and advanced proximally into the renal pelvis. Contrast was then injected through the Pollack catheter, and a retrograde pyelogram was performed. A collection of contrast could be seen; however, it did not appear to be filling out the calices of the transplant kidney. A jet of contrast could be seen superiorly suggesting that the Pollack catheter was not placed fully within the renal pelvis. The wire was, therefore, placed back through the catheter and advanced to the portion where the contrast jet had been seen. The wire was able to be passed through this presumed strictured area proximally into the renal pelvis.
The Pollack catheter was then placed over the wire and advanced by alternating and moving the wire forward and then the Pollack catheter over the wire. The wire and Pollack were able to be passed into the upper pole of the kidney. Contrast was then again injected, and another retrograde pyelogram was performed. This pyelogram did appear to fill out the calices of the kidney. There appeared to be tandem strictures, one at the presumed site of the anastomosis of the native and transplant ureter and a second stricture in some region of the transplant ureter. The wire was then placed again through the Pollack up into the upper pole of the kidney, and the Pollack was removed leaving the wire in place. The wire was then backloaded onto the scope, and the scope was replaced into the bladder.
An 8 x 16 double-J stent was placed over the wire and advanced proximally until the proximal portion was in the upper pole of the kidney. The wire was then removed. A good proximal curl was seen with fluoroscopy in the upper pole of the kidney and a good distal curl was seen under direct vision with the scope. The patient’s bladder was then drained and the scope was withdrawn. The patient tolerated the procedure well and was transferred to the postanesthesia care unit in stable condition. He did receive preoperative and postoperative antibiotics.
