[Verified Answer]: OPERATIONS PERFORMED: 1

OPERATIONS PERFORMED: 1. Cystoscopy. 2. Left ureteroscopy. 3. Laser lithotripsy of ureteral stones and basketing stone fragments. 4. Placement of double-J stent. ANESTHESIA: General. INDICATIONS: The patient is a 59-year-old male with a history of stone disease, who has severe left flank pain and was found to have an obstructing large left proximal ureteral stone. DESCRIPTION OF OPERATION: After induction of general anesthesia, the patient was placed in the lithotomy position. Genitalia were prepped and draped in the usual sterile fashion. A #21-French cystoscope was inserted under camera vision. The urethra was unremarkable. Prostate revealed early benign BPH, nonobstructive in nature. The scope was passed into the bladder. The bladder mucosa was normal throughout. Under fluoroscopic control, a guidewire was placed up the left ureter and bypassed the stone. This was difficult at first, but the guidewire was eventually manipulated around the stone into the proximal collecting system. A rigid ureteroscope was then negotiated up the left ureter alongside the guidewire up to the stone, which was at approximately the junction of the upper third and the middle two-thirds of the ureter. The stone was quite large and occupied the entire lumen of the ureter. Laser lithotripsy was then performed under camera vision. Using the Holmium laser, the stone was fragmented into multiple fragments, all of which were then individually basketed. Some of the stones were sent for analysis. Further ureteroscopy up to the kidney failed to reveal any significant sized fragments. Therefore, the ureteroscope was removed and a 24 cm length, #6 French diameter double-J stent was negotiated over the guidewire into the ureter and the guidewire was removed. The stent was seen curled in good position on cystoscopy. The procedure was well tolerated by the patient without complications. The patient was taken to the recovery room in stable condition.