Patient Note — 120913

4/14/26, 7:48 AM Print Preview [PATIENT_NAME] DOB: [DOB] (69 yo M) Acc No. [ACCOUNT_ID] DOS: 04/08/2026 Progress Notes Patient: [PATIENT_NAME] Provider: ASEEM MALHOTRA, MD Account: [ACCOUNT_ID] DOB: [DOB] Age: 69 Y Sex: Male Date: 04/08/2026 Phone: Address: [ADDRESS] Pcp: ALISA MILLER Subjective: Chief Complaints: 1. FOLLOW UP. HPI: BPH screening: 69yM, hx of CAD, ischemic cardiomyopathy, recent SDH, T2 DM, On Proscar, here today for 6-month FU He has had 2 URS (06/2025 and 3/2025) which are relatively concerning for fibrotic stricture however, the path remains negative. Second opinion (03/25/2026, Dr. Pratik Desai): Given the enlarging obstructing mass despite negative biopsies, recommend surgical resection of the affected ureteral segment with reconstruction. Non-smoker. No prior hx of kidney stones. - - - - - - - - - - - - - - - - - - Prior work-up: CTU (2/2026): 1.4cm soft mid left ureter lesion. 1.8cm benign L renal cyst in anterior interpolar region. Urocuff (1/2026): VV: 105ml, PVR: 22ml, Qmax: 3.2ml/s KUB (9/2025): Bilateral pelvic calcification, more on right than left. MRU (8/2025): 1.6 cm simple cyst in anterior interpolar region of R kidney. Left nephroureteral stent in place. No hydronephrosis, No urethelial mass and no lymphadenopathy and flow through. (reviewed and interpreted) NM Lasix renal Scan (07/2025): Asymmetric flow seen L kidney compared to R with delayed parenchymal accumulation likely related to diminished renal function. Split renal function 42% on L and 58% on R. Normal washout with Lasix indicates no obstruction. L URS Ureteral Bx, L retrograde pyelogram, L 6Fx26cm double J UR stent insertion(06/19/2025): L RPG demonstrated a focal stricture at the level of L5-S1 junction spanning 2 cm with goblet appearing and mild proximal hydroureter without hydronephrosis. Initial semi rigid URS was notable for fibrotic ureteral lumen with fibrotic intraluminal tissue without obvious mucosal or papillary change typically seen in urothelial malignancy. Multiple (6-8)biopsies with good tissue were obtained. L stent deployed. Path: Ureter L bx: Predominantly necrotic tissue admixed with marked chronic inflammatory cells. Chronic inflammatory cells, Scanty benign urothelial mucosa: Negative for dysplasia or malignancy in this scanty specimen. Fluoroscopy (06/2025)(<1 hr): Partial opacification L collecting system with stent placement. Cytology(06/2025): L ureter , washing: Benign. Negative for High-grade urothelial carcinoma. CTu ap w/wo cont(5/2025): Filling defect in left distal ureters is suspicious for urothelial neoplasm. No evidence of metastatic disease in the abdomen or pelvis. Whole blood Glu POCT(03/2025): 123 Cystoscopy, L RG pyelogram, interpretation of retrograde pyelogram, left semirigid ureteroscopy with ureteral bx(03/2025): bladder trabeculation. no bladder tumors. Left RPG: normal distal ureter, 2 cm ureteral narrowing overlying the SI joint. Dilation of the ureter proxima to this area. No intraluminal filling defect