Preparing for your laparoscopic pyeloplasty

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1 Preparing for your laparoscopic pyeloplasty Welcome We look forward to welcoming you to The Royal London Hospital. You have been referred to us for a laparoscopic pyeloplasty, which is an operation using keyhole surgery to improve the flow of your urine. This leaflet will tell you more about the procedure. Why do I need a pyeloplasty? Sometimes the funnel-shaped part of the kidney (known as the renal pelvis) is too narrow so that it cannot do its job and drain urine effectively. You may have been born with it like this or it may be due to an additional blood vessel crossing at that point. Blockages can occur at the junction with the ureter (which is the tube carrying urine to the bladder). The area affected is known as the pelviureteric junction (PUJ). You may have blockages around your left kidney, or right kidney, or on both sides. When blockages occur, symptoms can include pain, nausea, vomiting, urinary infections and kidney stones. Pyeloplasty is an operation that aims to widen the narrowed area, by removing the tissue that is causing an obstruction.

2 What is laparoscopic pyeloplasty? Laparoscopic pyeloplasty is a technique that uses keyhole surgery to unblock obstructions in the PUJ area. Keyhole surgery involves making tiny little cuts in the skin, rather than a big incision. A slim telescope and instruments are inserted through the little cuts and then surgery is carried out. You are left with minimal scarring and recovery is usually much quicker than with conventional open surgery. What happens on the day of the operation? Please do not eat anything for six hours before your appointment. You may continue to drink WATER ONLY up until two hours before your appointment. You will be asked to sign a consent form to give your permission for the operation to go ahead. You may have already signed a consent form when the decision was made with you to proceed with an operation, in which case we will reconfirm this with you. Then you will be provided with a gown to wear and given a general anaesthetic. Several small cuts will be made in the skin below your rib cage. A telescope will be inserted and your abdomen filled with carbon dioxide gas (to make it easier for the surgeon to see your internal organs). The narrowed area will be cut or removed and the ends of the ureter are then sewn back together. Sometimes, if there is a blood vessel in the way, it will be moved and fixed away from the narrowed part. An internal plastic tube (stent) will be inserted into your ureter to support the newly stitched wound until healing has finished. The stent will be removed three to six weeks after surgery under a local anaesthetic. The operation takes approximately two to three hours. What is a ureteric stent? A ureteric stent is a hollow tube made of flexible plastic that is placed inside the ureter (the tube that leads from your kidney to the bladder). It is held in place by coils at both ends. The top end coils in the kidney and the lower end coils inside the bladder to prevent the stent from slipping up or down. The stents are flexible enough to move with your body. What happens after the operation? You will be taken from the theatre to the recovery room, where you will be closely monitored until you are awake enough to return to the ward. You may have a catheter (tube) put in, to drain urine from your bladder. You may also have a drainage tube placed through your skin (to drain blood and debris). The tubes usually stay in for a day or so. You will be given intravenous fluids (a drip) to keep you hydrated. Following the operation you will probably feel a mild discomfort. Most patients will only need simple painkillers, but if you are in pain, you may be given stronger medication. You will probably remain in hospital for about two to three days. 2

3 How will I feel when I go home? You may only have had a few small cuts, but this is still a major operation and you will feel quite tired when you go home. It is important to rest and at first you may feel like having a sleep during the day. It is also important to take exercise regularly. This should be gentle at first but gradually built up as you start to have more energy. You should avoid heavy lifting or driving for about two to three weeks after your operation. What are the side effects of having a ureteric stent? Many patients with a stent carry on with their lives, without any difficulties. However most people will experience some side effects. These are usually minor, but in rare cases they can be severe. The main side effects include: Going to the toilet more often An urgent need to urinate Blood in the urine Feeling that the bladder isn t empty after going to the toilet Discomfort in the bladder and kidney area (and occasionally in other areas such as the groin, urethra and the genitals) Discomfort after physical activity Discomfort after passing urine. What happens if I see blood in my urine? It is usual to see some blood in your urine while you have a stent in. You should drink plenty of fluids to flush through your urinary system. If the bleeding becomes heavy and there are thick blood clots that block the flow of urine, you should contact your GP or go to your nearest A&E department. Will I be able to work after the procedure? Yes, but if your job involves heavy manual labour or physical activities then you may experience some discomfort. Any side effects such as urinary symptoms and pain may make you feel tired. You may wish to talk to your employer about temporarily adjusting your workload. You should avoid heavy lifting or driving for about two to three weeks after your operation. Can I do sports and other physical activities while my stent is in place? Yes, provided that you are fit and well enough to do so (ask your doctor for advice). However, you may experience some discomfort in the kidney area and passing of blood in your urine. You may also feel more tired than normal. 3

4 How can I reduce my risk of getting an infection? Every day, you should drink at least 2 to 2.5 litres of fluids (that s approximately five pints). Drink mostly water. This will help to minimise your risk of infection and will reduce the amount of blood in your urine. It will also help in the treatment of stones. Is it OK to take painkillers? Ask your doctor for advice before taking any medication. Are there any risks or complications associated with this procedure? General anaesthetics are very safe. However all operations carry some risks. With any surgery there is a small chance that you will develop a chest infection, a clot in your lung or leg, bleeding or heart problems. You will have the opportunity to discuss this with the anaesthetist before your operation. Complications and risks associated with laparoscopic pyeloplasty include: Temporary shoulder pain and abdominal bloating (common) Infection, pain or hernia of incision requiring further treatment (occasional) The narrowing can return, needing further surgery (occasional) Bleeding during the operation, which can lead to open surgery or blood transfusions (occasional). Alternative treatment Alternative treatments may include doing nothing and monitoring your kidney at regular clinic appointments, endopyelotomy (a procedure to widen the renal pelvis), and conventional open surgery (which will leave you with a bigger scar and a longer recovery time). Who can I contact for further information about my procedure? Please contact the Urology Nurse Specialist: Department of Urology, 9th Floor, The Royal London Hospital, Whitechapel, London, E1 1BB Fax:

5 Patient Advice and Liaison Service (PALS) If you need general advice or support with our services, including help with any concerns you may have, please contact the Patient Advice and Liaison Service (PALS) for The Royal London Hospital: Tel: or Fax: Large print and translations For this leaflet in large print, please ring or For help in interpreting this leaflet in other languages, please ring Your health records To enable us to improve the quality of the care that we provide, your health records are kept by the Trust and may be used for teaching, training, audit and research. Further information on how the Trust uses your information can be found on our website at Reference: BH/PIN/29 Publication date: July 2012 All our patient information leaflets are reviewed every three years. 5