ok here goes:Any suggestions on the following?
SERVICES PROVIDED 1. Placement of a right double J ureteral stent. 2. Ureteral dilatation. 3. Antegrade pyelogram to preexisting catheter. 4. Exchange of 10-French PCN drainage catheter. 5.
Intravenous moderate sedation.
22 minutes 8 seconds
6306 cGy cm2
Abdominal CT 11/06/2010.
30 mL Isovue 300
The procedure was explained in detail to the patient. Potential risks, benefits and alternative therapies were discussed.
All questions were answered and informed consent was obtained.
The patient was given IV moderate sedation throughout the procedure, using IV Versed and Fentanyl. The patient was monitored with automatic blood pressure cuff measurement, EKG and pulse oximetry during the procedure.
Medications were administered by an RN under the direct supervision of the IR attending.
With the patient positioned in a slightly prone to left lateral decubitus, the patient's right back, flank and preexisting PNC catheter was sterilely scrubbed, prepped and draped in the standard fashion. A small amount of water soluble contrast media was injected through the preexisting catheter and an antegrade pyelogram obtained. The 10-French PCN drainage catheter was removed over a 0.035 wire. A 5-French angled catheter was then guided over the wire fluoroscopically down the right ureter to the distal right ureteral obstruction. Using various catheters and wires, access was finally gained across the distal ureteral obstruction and into the bladder.
Catheter positioning within the bladder was documented with a small amount of contrast.
Over a 0.035 stiff wire, the distal ureteral obstruction was angioplasty with a 4-mm balloon. Following angioplasty and measurements, an 8-mm x 26-cm long double J ureteral stent was then placed over the wire down the ureter and positioned with pigtail in the bladder and renal pelvis. A new 10-French PCN drainage catheter was then placed through the same access and positioned within the renal pelvis. Antegrade pyelogram was obtained showing unobstructive flow down the right ureter and into the bladder.
There is no evidence of extravasation at the site of the angioplasty.
COMPLETE DISTAL RIGHT URETERAL OBSTRUCTION SUCCESSFULLY TRANSVERSE AND ANGIOPLASTIED WITH 4-MM BALLOON.
PLACEMENT OF AN 8-FRENCH, 26-CM LONG DOUBLE J URETERAL STENT FOR INTERNAL DRAINAGE OF URINE.
REPLACEMENT OF THE 10-FRENCH PCN DRAINAGE CATHETER FOR EMERGENT ACCESS TO BE REMOVED NEXT WEEK UNDER FLUOROSCOPY IF AGREEABLE WITH THE PRIMARY SERVICE.
50393/74480 Ureteral Stent
50398/75984 Nephrostomy Exchange
50394/74425 Pyelogram through existing catheter
50395 Dilation of Ureter to establish nephrostomy track.
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