PROCEDURE: 

  1. Antegrade nephrostogram through existing catheter.
  2. Placement of left ureteral stent.

INDICATION:  The patient is an __ year female with metastatic bladder carcinoma and left ureteral obstruction.  Patient had left nephrostomy tube placed at an outside institution. Patient presents for internalization.

DATE OF PROCEDURE: January 1, 2022

PHYSICIANS: Drs. [] (Attending), [] (Fellow)

MEDICATIONS: Versed 4 mg IV, fentanyl 300 ug IV, and Phenergan 25 mg IV, Levaquin 500 gm IV.

CATHETER: 10 French x 20 cm JJ ureteral stent.

 

PROCEDURE:

The risks benefits and alternatives of the procedure as well as conscious sedation were discussed with the patient. After obtaining informed consent the patient was placed in the prone position on the angiography table and was prepped and draped in the usual sterile fashion. 1% lidocaine was used as local anesthetic. An antegrade nephrostogram was performed through the existing nephrostomy tube. 

An 0.035 Bentson wire was advanced through the tube into the renal pelvis and down into the ureter. An 8 French Vascular sheath was advanced. A Berenstein catheter was advanced over the wire advanced into the distal left ureter. Contrast was injected the catheter demonstrated complete obstruction the distal ureter. A 0.035 angled Glidewire was advanced to the catheter and finally negotiated past obstruction into the ileal conduit. A 5 French Berenstein catheter was then advanced over the wire. The length of the ureter was then measured with the wire. A 0.035 Amplatz stiff wire was re-advanced into the bladder and the catheter was removed. Finally a 10 French x 20 cm ureteral stent was advanced with the cope loop formed within the renal pelvis and bladder. 

The patient tolerated the procedure well and left the angiography suite in stable condition without any immediate postprocedural complications.

 

FINDINGS:

  1. Moderate hydronephrosis and hydroureter to the level of the distal left ureter. There is questionable small extravasation of contrast at the obstruction which may be due to a ureteral leak.

 

IMPRESSION:

  1. Successful internalization of the nephrostomy tube an internal JJ ureteral stent