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Getting mixed answers on this one too! PROCEDURE(S): Percutaneous Nephroureteral Stent Placement (Internal/External) Foreign Body Retrieval - Non Vascular HISTORY: Nephrolithiasis INDICATION: Urinary Obstruction MEDICATIONS: Fentanyl 200mcg; Midazolam 6mg CONTRAST: Omnipaque 350, 30 ml 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 right flank was prepped and draped in the usual sterile fashion. Local anesthesia with two lidocaine 2%. Puncture of the right renal pelvis was performed using Chiba 22 gauge needle. Contrast and air was injected and spot film imaging was performed as a percutaneous antegrade pyelogram. A posterior upper pole calyx was then punctured under fluoroscopic guidance using a 21 gauge needle. A Jeffrey sheath dilator set was placed. Catheter access to the bladder was achieved using a 5-French Bernstein catheter and angled Terumo guide wire. An Amplatz super stiff wire was placed. Over the wire a 9-French vascular sheath was placed. Through this a 25-mm Amplatz gooseneck snare was advanced and used to engage the occluded internal ureteral stent. The sheath and ureteral stent were then removed intact while maintaining wire access. Over the wire, a 10.2 French x 22-cm percutaneous internal/external nephroureteral stent was placed. The distal loop was formed in the bladder and proximal pigtail was formed and locked in the renal pelvis. Post placement nephrostogram confirmed appropriate position. The catheter was sutured to the skin and placed to external drainage. FINDINGS: There is moderate right hydronephrosis, especially a lower pole calyx. There is a large stone impacted in the renal pelvis, which partial balloon partially obstructs the lower pole calyx. The internal ureteral stent was occluded. This was successfully removed. INTERPRETATION:Successful percutaneous drainage of the right kidney with placement of a percutaneous internal/external nephroureteral stent as described above.