I'm just curious to see how others would code this case...thanks!
COMPLICATIONS:
None.
TECHNIQUE: Following informed consent and verification of the correct patient identity and planned procedure, the patient was placed in the prone position and the left flank was prepped and draped in the usual sterile fashion. Puncture of the left renal pelvis was performed using Chiba 22G needle. Contrast and air was injected and spot film imaging was performed as a percutaneous antegrade pyelogram. A posterior lower pole calyx was then punctured under fluoroscopic guidance using a 21G needle. A Jeffrey sheath dilator set was placed. Catheter access to the ureter was achieved using a five French Bernstein catheter and angled Terumo guide wire. An Amplatz Extra Stiff wire was placed. Through an 8Fr sheath, a 20mm snare was used to removal the inwelling JJ stent intact. Over the wire, an 8Fr sheath was reinserted. Through the sheath, the Terumo wire was reinserted into the ureter. Over the Terumo wire, a 5Fr bernstein catheter was advanced into the distal ureter. Over the Amplatz Extra Stiff wire, a 10.2Fr Multipurpose Drain was placed. The pigtail was formed and locked in the renal pelvis. The nephrostomy catheter was sutured to the skin and placed to external drainage. The 5Fr catheter was capped and sutured to the skin.
FINDINGS:
There is a bifurcated collecting system with stones in at least two different upper pole calyces. Therefore, a lower pole access was selected and performed as described.
INTERPRETATION:
1.Successful percutaneous drainage of the left kidney with placement of a 10.2Fr Multipurpose Drain nephrostomy tube and a 5Fr nephroureteral stent as described above.
2. Successfule snare removal of the left inwelling internal ureteral stent.
COMPLICATIONS:
None.
TECHNIQUE: Following informed consent and verification of the correct patient identity and planned procedure, the patient was placed in the prone position and the left flank was prepped and draped in the usual sterile fashion. Puncture of the left renal pelvis was performed using Chiba 22G needle. Contrast and air was injected and spot film imaging was performed as a percutaneous antegrade pyelogram. A posterior lower pole calyx was then punctured under fluoroscopic guidance using a 21G needle. A Jeffrey sheath dilator set was placed. Catheter access to the ureter was achieved using a five French Bernstein catheter and angled Terumo guide wire. An Amplatz Extra Stiff wire was placed. Through an 8Fr sheath, a 20mm snare was used to removal the inwelling JJ stent intact. Over the wire, an 8Fr sheath was reinserted. Through the sheath, the Terumo wire was reinserted into the ureter. Over the Terumo wire, a 5Fr bernstein catheter was advanced into the distal ureter. Over the Amplatz Extra Stiff wire, a 10.2Fr Multipurpose Drain was placed. The pigtail was formed and locked in the renal pelvis. The nephrostomy catheter was sutured to the skin and placed to external drainage. The 5Fr catheter was capped and sutured to the skin.
FINDINGS:
There is a bifurcated collecting system with stones in at least two different upper pole calyces. Therefore, a lower pole access was selected and performed as described.
INTERPRETATION:
1.Successful percutaneous drainage of the left kidney with placement of a 10.2Fr Multipurpose Drain nephrostomy tube and a 5Fr nephroureteral stent as described above.
2. Successfule snare removal of the left inwelling internal ureteral stent.