PROCEDURE IN DETAIL: The patient was brought to the operative suite. Appropriate monitors were established and preoperative antibiotics were administered. The patient was prepped and draped in the low dorsal lithotomy position. Cystourethroscopy was performed and was characterized by an edematous left orifice and intramural ureter tunnel. There were no foreign bodies in the bladder. The bladder was otherwise normal. The patient had a Pollack catheter and Bentson guidewire readied and attempts were made to pass this past the stone; however, they proved futile and it was necessary to go to a combination glide and Bentson wire. This was successfully maneuvered past the calculus and allowed to rest in the pelvis of the kidney. The ureteroscope was then readied, and using saline as irrigant, was successfully passed into the orifice and the stone could be seen. Attempts were made to engage the stone with two different stone baskets; however, they kept collapsing and would not open enough to engage the stone. Accordingly, it was elected to employ the holmium laser and the laser fiber was introduced. It was then used to fragment the stone into several pieces, which were extracted from the ureter using the baskets. Several were retained for analysis. The guidewire was then backloaded through the cystoscope and a 6 x 20 double-J stent was readied and passed over the guidewire, positioned by fluoroscopic imaging as well as, visually, distally in the bladder and the suture was left on it. The guidewire was removed after satisfactory positioning of the stent had been achieved. The bladder was then drained and several more fragments were evacuated with blood clots. The suture was allowed to exit the urethra and was taped on the patient's thigh and the procedure terminated. The patient was taken to the recovery room in satisfactory condition.
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