PYELOPLASTY (LAPAROSCOPIC AND OPEN PROCEDURE)

Transcription

1 PYELOPLASTY (LAPAROSCOPIC AND OPEN PROCEDURE) AN INFORMATION LEAFLET Written by: Department of Urology May 2011 Stockport: Website: w w w. s t o c k p o r t. n h s. u k Tameside: /6698 Webs ite: w w w. t a m e s i d e. n h s. u k Macclesfield: Pyeloplasty 1 of 6

2 Urine is made by the kidneys and travels down through ureters (tubes) into the bladder. If the top end of the ureter, which connects to the kidney is narrowed or tight, urine cannot drain away properly and builds up in the kidney, making it swell with extra fluid (hydronephrosis). The medical term for the narrow connection is pelvi-ureteric junction obstruction (PUJ obstruction) and if not treated, can lead to damage in the kidney. What is a Pyeloplasty? Pyeloplasty is the operation performed to repair the narrowed connecting section of the ureter, so that the urine can flow more easily. The operation can be an open procedure (through a cut/incision in your lower back, front or side) or as a laparoscopic procedure (using telescopic instruments via 3 to 5 small incisions on the side of the abdomen of the affected kidney). A stent (small plastic tube) is inserted into the ureter at the end of the operation, to support and protect the pyeloplasty repair. This stent is normally left in for 4 to 6 weeks after the operation, and then removed under a local anaesthetic at your local urology department. The operation is carried out under a general anaesthetic (where you are put completely to sleep) and you should expect to be in hospital between 3 to 7 days, depending on the type of wound site (open or laparoscopic) and your recovery rate. What Are The Benefits? A pelvi-ureteric junction obstruction can cause pain, urinary infections, kidney stones and high blood pressure, as well as deterioration of kidney function. Are There Any Risks Involved? Both types of operation; Bleeding There is a risk that bleeding could occur during either operation, but this is usually a small amount of bleeding, which does not cause any problems and blood transfusion is not normally required. Infection If you experience a high temperature, a reddened or inflamed-looking incision site, oozing, pus or increased pain around the incision or any other symptoms that make you think that you may have an infection, you may require antibiotic treatment and should see your GP as soon as possible. Pain You should expect some discomfort after either operation, which should be easily controlled by painkillers, given to you by the nursing staff looking after you. Organ injury This is uncommon, although surrounding tissue and organs may be injured during the operation. Failure to Correct the PUJ Obstruction A special x-ray test (renogram) which you should have had done before your operation to check on the function of your kidneys, will be repeated sometime after your operation to evaluate its results. If the obstruction has not improved (possibly due to recurrent scarring) further surgery may be necessary. Complications of reduced mobility - The nurses on the ward will encourage you to move around as soon as you feel up to it, to avoid possible complications such as deep vein 2 of 6

3 thrombosis/dvt (formation of a blood clot in the veins in the leg) or chest infection (which can be prevented by regular deep breathing exercises and a physiotherapist may visit you on the ward to teach you how to perform these). Risks Specific to Laparoscopic Procedure Conversion to open procedure There is a one in ten (10%) chance that the Surgeon may have to proceed to an open procedure (larger incision) to complete the procedure if it is not progressing as well as expected. Risks Specific to Open Procedure Longer stay in hospital Due to the larger wound site, you may experience more pain and find it difficult to move around to begin with. The length of stay in hospital is longer than if the surgery had been performed as a laparoscopic operation. What Are The Alternatives? Balloon dilatation This involves stretching the narrowed area using a balloon passed up from the bladder. It does not involve any cuts and access is gained via the urethra (the tube you pass urine through). The results are unpredictable and not all patients are suitable for this technique. What Happens To Me When I Arrive At The Ward? Your operation will be performed at Stepping Hill Hospital, Stockport. You will be met by the nursing staff looking after you and an anaesthetist will talk to you about your anaesthetic. On the Day of the Procedure You will have nothing to eat or drink for several hours before the operation. If you would normally take tablets during this time, please ask at the pre-operative assessment clinic which you should continue to take. Before going to the operating theatre, you will be asked to change into a theatre gown. All make-up, nail varnish, jewellery (except your wedding ring), dentures and contact lenses must be removed. What Happens After The Procedure? After the operation you will have an intravenous drip in your arm, to give you fluid to make sure you do not get dehydrated. This will stay in place until you are able to eat and drink, usually 1 to 2 days after the operation. You may experience some pain, and should request painkillers to keep you comfortable from the nurses looking after you. You may be connected to a machine containing painkillers (PCA) which you control yourself, and the nurse will show you how to use this.

4 If you have had laparoscopic surgery you may experience some shoulder or stomach pain for up to 2 days following the operation. This is due to the gas used to inflate your stomach during the operation, to give a better view and is often described by patients as wind like pain. You will have a catheter (tube draining urine from your bladder), so that your urine output can be monitored closely. This is usually removed after about 2 to 4 days. You will also have a wound drain (tube coming out a small incision in your side). This is to prevent blood and fluid building up around the kidney and repair site. This drain is usually removed the same day as the catheter. You will be monitored closely by the nursing staff on return to the ward from the operating theatre. They will regularly take your blood pressure, pulse and possibly temperature and respiration rate. You will be encouraged to move around the ward, as soon as you are able following your surgery. Discharge Arrangements It is necessary to arrange for a responsible adult to collect you from hospital and take you home. You will be given a seven day supply of any new medications prescribed for you. It may be arranged for a District Nurse to visit you at home to check on your wound-site, stitches or progress, should the urology team feel this is necessary. You will be given an appointment to return to your local urology department, approximately 4 to 6 weeks after the operation, to have the stent removed. This is performed via a flexible cystoscopy under a local anaesthetic (camera inserted into the urethra and passed up into the bladder, through which grasping forceps can retrieve the stent and remove it via the urethra). If you have any pain you should take painkillers as prescribed / required. A letter will be sent to your GP informing them of the operation, your progress and any follow-up arrangements required. Day To Day Living Following Laparoscopic Pyeloplasty; You should take gentle exercise (walking) but should avoid strenuous exercise (jogging, swim ming) and heavy lifting for approximately 3 weeks after the operation. You can expect to return to work after about 3 to 4 weeks. You should avoid driving for 3 weeks, or until you think you could perform an emergency stop without causing any discomfort at your wound site. You should check with your insurance company about driving following this type of surgery. The stent in the ureter can cause some irritation, leading to urinary frequency, urgency or pain on passing urine. These symptoms often improve with time and should disappear when the stent is removed. You should keep your wound site clean and dry by showering regularly and gently patting dry your wound site.

5 Following Open Pyeloplasty; You should avoid any exercise and heavy lifting for about 8 weeks following surgery. You should get back to feeling like your normal self after 2 to 3 months following this operation and can return to work about this time, or when you feel able. You should avoid driving for about 4 weeks following surgery and should check with your insurance company about insurance cover following this type of surgery. You should not drive until you think it would be comfortable to perform an emergency stop. The stent in the ureter can cause some irritation, leading to urinary frequency, urgency or pain on passing urine. These symptoms often improve with time and should disappear when the stent is removed. If there is a Problem? If you experience any problems following the procedure, please contact your GP immediately. If you have any questions you want to ask, you can use this space below to make notes to remind you. Source While compiling this information leaflet, a number of recognised professional bodies have been used, including the British Association of Urological Surgeons. Accredited good practice guidelines have been used. If you have a visual impairment this leaflet can be made available in bigger print or on audiotape. If you require either of these options please contact the Health Information Centre on

6 If you would like any further information please telephone the Urology Nurse Specialists at your local Urology Department on: Stepping Hill Tameside /6696 Macclesfield Author: Urology Department Division/Department: Elective Services Date Created: 2004 Reference Number: Version: Version 1.2