Urology Department. Laparoscopic Pyeloplasty. Information

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1 Urology Department Laparoscopic Pyeloplasty Information

2 Aims of this leaflet To give information on the intended benefits and potential risks of kidney surgery. To guide you in the decisions you will make with your doctor. To help you identify questions about issues which are important to you. What is a Laparoscopic Pyeloplasty? This is the repair of a narrowing where the ureter joins the renal pelvis and part of the kidney. It is performed through 3-4 small keyhole incisions and involves the insertion of a temporary ureteric stent to aid healing. Benefits Removal of narrowed ureter allowing the kidney to drain urine Prevention of future health problems 2

3 What should I expect before the operation? Pre-operative Assessment You will be asked to attend a pre-operative assessment clinic to assess your general fitness for surgery. This will be carried out by one of the pre-operative assessment nurses. You will be required to have some baseline blood and urine tests and may require an x-ray and heart tracing (ECG). Please allow at least two hours for this appointment. Your Hospital Admission Most patients are admitted on the day of their operation. In preparation for your admission please bring with you your regular medications, toiletries and reading material as desired. Visiting times vary from ward to ward, so please check with the staff on arrival at your ward. On arrival at the ward a member of the nursing staff will admit you. You will be shown the ward layout and the nurse will be able to answer any questions you may have. Please shower on the morning of your operation. Getting ready for theatre Shortly before being taken to theatre you will be given a gown to put on. You will also need to wear anti-thrombosis stockings during your hospital stay. These help prevent blood clots forming in the veins of your legs during and after surgery. You will then be seen by a member of the medical team, which may include your consultant or registrar who will ask you to sign a consent form. They will confirm the site of the operation if required, which will be marked using a pen. 3

4 Anaesthetic It will be necessary for you to have a general anaesthetic for your operation. Before the anaesthetic you must not eat or drink for a stated period of time, which is usually 6 hours before surgery. The anaesthetist will see you on the ward before your operation. They will discuss the anaesthetic with you and answer any questions you may have. You will be advised which of your regular medications you need to take before going to theatre. They will be responsible for looking after you throughout the operation. A member of the ward staff and a porter will take you to theatre on your bed. Theatre Department On arrival in the theatre area you will be introduced to a member of theatre staff who will ask you to confirm your name and date of birth, checking these details with your medical notes and name bracelet. You will be asked to confirm what operation you are having and the last time you had anything to eat and drink. What happens during the operation? You will be taken to the theatre where your operation will be performed. The anaesthetist will meet you with their assistant before putting you off to sleep for the duration of the operation. Through keyhole incisions, the surgeon will remove the blockage at the junction between the kidney and ureter. The ureter is then joined / stitched back onto the kidney allowing free drainage of urine down the ureter. A ureteric stent is inserted to allow the join between the renal pelvis and the ureter to heal. 4

5 What happens immediately after surgery? You will be taken to the recovery area where you will be looked after by a nurse until the staff are happy for you to return to the general ward. When you wake up, you will have several different tubes in place. This can be off putting to see but it may help to know what they are all for: A drip into a vein to give you fluids until you are eating and drinking again, painkillers or intravenous antibiotics. A drain placed through your skin to prevent fluid collecting at the operation site. A tube into your bladder (urethral catheter) so that your urine output can be measured. Possibly a small catheter in your back for pain relief (epidural). You will have a blood pressure cuff on your arm when you first wake up and a little clip (called a pulse oximeter) on your finger to measure your pulse and the oxygen levels in your blood. You may also have an oxygen mask on for a while. Pain relief After surgery you will need some pain relief for the first few days. It is important to tell your doctor or nurse as soon as you feel any pain that is not tolerable. Pain relief medicine works best when you take them regularly so please don t suffer in silence. You may have an epidural placed during surgery or alternatively you may be given Patient Controlled Analgesia (PCA) via a drip. Both involve having a button, which you can press to release pain killers through your drip when required. 5

6 Do tell your nurse if you need to press the button very often as the dose in the pump may need to be increased. You can t overdose the machine is set to prevent that. Blood Clot Prevention You will be provided with stockings to wear before the operation, which you need to keep on for the duration of your stay. You will also be given a small, daily, injection into your abdomen to try and prevent blood clots in the legs and lungs. These injections will be carried on for 4 weeks following your operation. We encourage patients to start walking as soon as possible. Eating and Drinking After surgery, you will be able to have clear fluids. If tolerated you can then try something like tea or soup before moving on to a normal diet the day after your surgery. Your wound You will have 3-4 small incisions covered with dressings on your abdomen. Your stitches will be dissolvable and therefore do not require removal. Occasionally, they persist for some weeks but eventually dissolve or fall out. Getting up Moving about helps you to get better more quickly, but you will need to start very gradually. On the first day following surgery, you will be encouraged to get out of bed, sit in a chair and to walk up and down the ward. Such activity is very important as it helps prevent clots in the legs and chest infections. 6

7 Removing tubes and drains Nurses will help you with all the drips and drains when moving around. With each tube that is removed, you will feel that you are getting back to normal. The catheter in the bladder will most likely be removed the day after surgery followed by the drain on the second day. On discharge from the hospital Gradually you will start to feel better during your stay though you will have some days where you feel better than others. The average hospital stay is usually between 2 to 4 days. When you leave hospital, you will be given a discharge summary. This contains important information about your stay in hospital and your operation. If you need to call your GP or if you need to go to another hospital, please take this summary with you so the staff can see the details of your treatment. This is important if you need to consult another doctor within a few days of being discharged. 7

8 What should I expect when I get home? How long will it take to recover? It will take 10 to 14 days to recover fully from the procedure and most people can return to normal activities after 2 to 4 weeks. Should I experience any continued pain? There may be some discomfort from the small incisions in your abdomen but we will send you home with simple pain relief. Occasionally, some patients may have discomfort in the wounds, which can take several months to settle down. You may find that the lower end of the ureteric stent, which sits in the bladder, can cause pain when you pass urine and you may also see blood in the urine. The stent can also cause you to pass urine more frequently than you would do normally. These symptoms will settle down once the stent has been removed. Driving after surgery It is your responsibility to make sure you are fit to drive a vehicle safely following your operation. You do not normally need to tell the DVLA that you have had surgery, unless you have a medical condition that will last for longer than three months after your surgery and may affect your ability to drive. You are advised to check with your insurance company before starting driving again. 8

9 General advice once home When you are discharged from hospital you should: Avoid heavy lifting or any strenuous activities for the first few days You can do normal, non-strenuous, daily activities, as you feel able Keep the wound as clean as possible. If it appears to be becoming increasingly painful or red, or if you develop a temperature, contact your GP. How will you be followed-up after surgery? The ureteric stent will be removed about 4 weeks after your operation in the endoscopy department. This is done by inserting a small telescope into the bladder and removing the stent under local anaesthetic. Occasionally patients opt for removal under a general anaesthetic. A urology outpatient appointment will then be made for you approximately 3 months after the date of surgery, followed by a radio-isotope scan and further clinic appointment at 12 months to assess the results of the operation. What are the potential risks? Most procedures have potential side effects. You should be reassured that, although all these risks are well recognised, not all patients will suffer from them. 9

10 The commonest side effects or risks of surgery are bleeding, infections and blood clots. Other potential risks are as follows: Common (greater than 1 in 10)* Temporary shoulder tip pain Denise: 2 readers ask: s this correct? Temporary abdominal bloating Temporary insertion of a bladder catheter and wound drain Further procedure to remove the ureteric stent. Occasional (between 1 in 10 and 1 in 50)* Bleeding, infection, or pain Hernia at the site of the keyhole incision requiring further surgery Recurrence of narrowing can occur, needing further surgery. Rare (less than 1 in 50)* Bleeding needing conversion to open surgery or requiring blood transfusion Recognised (or unrecognised) injury to nearby organs or local structures including blood vessels, spleen, liver, pancreas and bowel, which may require conversion to open surgery (or deferred open surgery). Need to remove the kidney at a later stage because of damage caused by recurrent obstruction. Anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and possibly death). 10

11 Contact Information If you require any further information, please contact: One of the Urology Nurse Practitioners on: Urology department, or and ask for these bleep numbers: 649/108 References *Information for this leaflet has been referenced from 11

12 If you need this information in another format or language, please telephone Further information about the Trust is available on the following websites: KGH - NHS Choices - Ref: PI 977 January 2016 Next review: October 2017

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