Place patient into urodynamics chair with the fluoroscopy arm to your left and the cystoscopy monitor to your right when facing the patient.
 

Have them sit and open their legs fairly wide so you can easily see the vagina and hopefully the urethra and ask then to relax as best they can.
 

Place the Valium 10 mg suppository and then betadine spray prep the urethra and vagina.
 

Place a 16F Foley catheter and drain the urine and send this office for our urine cytology.
 

Apply the lidocaine per urethra at least 10 mls.
 

Give them a Toradol 30 mg IM.
 

Then place the sterile prep sheet [make sure big enough to cover entire patient and most of the chair] with the rectangle opening of the sheet over the vagina and tell them to keep arms on the side arm rests to both their sides.
 

Then wait 20 minutes and check on them to see if they are drowsy or very relaxed and slow to answer your questions.
 

Load the rigid cystoscope with a right and left working channel 5F yellow open ended ureteral catheter and thread them to the end of the scope.  Then prepare two, 20 mls syringes with a 50:50 dilution of dye mixed with equal amounts of saline.  Connect the syringes to the catheter ends and run enough dye through the tips of the catheters until you see dye coming out the end of the scope.  Then remove the syringes and keep them ready to soon be refastened to the ureteral catheter.
 

Then call me to come in.
 

I will then enter the room and start talking to the patients letting them know we are getting ready to start the procedure.
 

I will then place the scope and quickly look around and we do a urine cytology.  Then I will advance the right ureteral catheter then the left ureteral catheter up the ureter then remove the scope leaving the ureteral catheters in place in the bladder and ureter.
 

You will then bring the fluoroscopy arm around with the fat part in front of the patient’s abdomen and we will spot fluoroscopy to make sure both catheters are in proper position.
 

Then simultaneously I will inject dye through each ureteral catheter about 10 mls while slowly pulling the catheters out as I instruct you to fluoroscopy continuously until I tell you to stop.  Amy will then take multiple pictures as we fluoroscopy of the dye in and leaving the kidneys and ureter.
 

After we inject all the dye I remove the catheters and we spot fluoroscopy the patients after 3 minutes to see how much dye has been expelled from each kidney and I write this information on the operative report as a percent of dye left in the kidney similar to the Mag-3 with Lasix washout we order at the hospital.
 

Make sure patient is sent home with Levaquin 750 #3, Norco 10 mg #10, and a follow up office appointment in 2 weeks to discuss the urine cytology results.
 

If we are doing a stent we will leave the ureteral catheter in place after we shoot the dye, then place a 0.035 Sensor guidewire through the catheter under fluoroscopy, then remove the ureteral catheter leaving the guidewire in place, then I will push the stent up the guidewire with the pusher until it’s in the bladder under fluoroscopy. Then we are done.