PROCEDURE: 

  1. Right antegrade nephrostogram
  2. Right percutaneous nephroureteral stent exchange

INDICATION: __ year-old male with invasive bladder cancer needing nephroureteral stent exchange with plant to convert to internal double J stent. Patient continues to have tube connected to gravity drainage.

DATE: 

OPERATORS: 

MEDICATIONS: Levaquin 500 mg IV, Versed 2 mg IV, fentanyl 200 mcg IV

FLUOROSCOPY TIME: 3 minutes

CONTRAST: 15 ml of nonionic contrast

CATHETER: 8 F nephroureteral stent

COMPLICATIONS: None immediate

 

TECHNIQUE:

The risks, benefits, and alternatives to the procedure and sedation were explained. Written informed consent was obtained. A surgical timeout was performed.

The existing catheter and surrounding soft tissues were prepped and draped in sterile fashion. Local anesthetic was injected at the catheter entry site. A scout radiograph was obtained.

Non-ionic contrast was injected through the existing nephroureteral stent and images of the collecting system obtained.

A 0.035-inch Amplatz wire was advanced through the nephroureteral stent and coiled within the urinary bladder. The tube was removed over the wire under direct fluoroscopic visualization.  A new 8 F nephroureteral stent was advanced over the wire and the Cope loop formed and locked in the renal pelvis and urinary bladder. Contrast injection confirmed location. The catheter was sutured to the flank with 0-0 Prolene and capped. A sterile dressing was applied.

The procedure was well tolerated, and the patient was discharged from the angiography suite in satisfactory condition.

 

FINDINGS: Comparison is made to a previous exam dated ______.

  1. Antegrade flow of contrast from renal pelvis to urinary bladder was seen prior to NUS exchange.
  2. Uneventful exchange of 8 Fr x 24 cm nephroureteral stent.

IMPRESSION: 

Uneventful image-guided replacement of a right nephroureteral stent as described above.

 

PLAN: Patient instructed to keep tube capped and return in 1 week for internalization to a double J stent. He was also advised to reconnect to gravity drain if nausea/vomiting/fever/chills/abdominal pain and to call on-call interventional radiologist for any concerns. A gravity drain was sent home with the patient.