HISTORY: The pаtient is а 38-yeаr-оld female whо develоped abdominal pain and symptoms of a urinary tract infection (UTI) 10 days ago and was admitted to the hospital. She was found to have a left ureteral stone, and small bilateral renal stones, as well as bilateral hydronephrosis and UTI. It was recommended that the left ureter be dilated and stented because of the hydronephrosis and the infection. Once the infection has been adequately treated, she will undergo ESWL of the ureteral stone at a later date. OPERATIVE FINDINGS: The urethra is normal. The bladder is smooth and without stone or tumor. Orifices are in normal location bilaterally. Right retrograde pyelogram showed no evidence of persistent filling defect; however, there is dilation of the collecting system and very mild hydronephrosis on the right side. One the left side, there was a 1-cm stone over the left ureterovesical junction with ureteral dilatation both distal and proximal to this, but especially proximal, and also left hydronephrosis. No other obvious stones were identified. DESCRIPTION OF PROCEDURE: The patient was taken to the operating area whereshe underwent IV sedation without problems. Following successful anesthesia, she was placedin the dorsal lithotomy position and prepped and draped in the sterile fashion. A #21 Frenchcystoscopy with lens was introduced into the bladder and thorough inspection of the bladder and urethra was carried out. Following examination, bilateral retrograde pyelograms of the kidneys, ureters and bladder were obtained and reviewed. Next, under fluoroscopic control, a .035 guidewire was placed up to the left orifice into the renal pelvis. Over this, the left ureter was dilated and a 24 cm × 6 F double-J stent was passed without problems, so that the proximal end curled in the left renal pelvis, and the distal end curled in the bladder. The bladder was then evaluated and the cystoscope was withdrawn. The patient was awakened and transported to the recovery room in good condition, tolerating the procedure well. She will be kept on a course of Ampicillin 500 mg 4 times a day for the next week and will then return at that time for ESWL of her left ureteral stone at a later date. Principal Diagnosis: Secondary Diagnosis: Principal Procedure: Hint: code the pyelogram as the secondary procedure Secondary Procedure:
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