Procedure : Procedure(s):
Left ureteroscopy, renal stone basketing, ureteral stent exchange.
A 30 degree cystoscope and a 22 French sheath was advanced to the patient’s urethra without difficulty. Upon entering the bladder cystoscopy was performed in a stepwise uniform fashion including the dome, left lateral wall, right lateral wall and base. No gross abnormalities were noted. Left ureteral stent was withdrawn and replaced by 2 0.35 glide wires. A rigid ureteral scope advanced over the 2nd wire up to the level of the UPJ, stone was identified then retropulsed back into the kidney. Rigid ureteral scope withdrawn and flexible ureteral scope advanced over the 2nd wire. Stone was grasped and removed in its entirety utilizing a 0 tip Nitinol basket. Ureteral scope was then readvanced up to the renal pelvis and pan pyeloscopy performed. Two large clots were grasped and removed to aid in visualization her previously noted 4-5 mm stone in the lower pole was identified and grasped with a 0 tip Nitinol basket and removed in its entirety as well. A final pan pyeloscopy was performed and no additional stones were identified however there was a significant amount of clot which could have obscured a small fragment. Ureteral scope was withdrawn and cystoscope advanced over the remaining wire over which a 6 x 26 double-J ureteral stent was advanced until good curl noted in both the left renal pelvis and bladder as seen on fluoroscopy and direct visualization. Patient’s bladder was drained and stent strings affixed to her thigh. Procedure was concluded.
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