Indwelling ureteral stent is replaced with a super-stiff guidewire which is maneuvered into the renal pelvis. This guidewire is covered with a 5 Fr. open-ended catheter. This promotes a continuous flow of irrigating fluid and maintains low pelvic pressure. Insulates the guidewire, preventing electro-cautery from making contact with the guidewire. This serves as an additional safeguard.
Urinary bladder is drained.
The cold knife is in place during this passage. Once the UPJ is reached, the cold knife is exchanged for the electrocautery element. Electrocautery will not work in the presence of normal saline. Perhaps removing the guidewire from within the 5 Fr. open-ended catheter should create a continuous flow system. The UPJ is incised laterally.