Laparoscopic Pyeloplasty is used to correct a blockage or narrowing of the ureteropelvic junction (UPJ) which results in poor drainage of urine from the kidney causing abdominal or flank pain stones infection, fever, high blood pressure, and deterioration of kidney function

When compared to the conventional open surgery, laparoscopic pyeloplasty has resulted in significantly less post-operative pain, a shorter hospital stay, earlier return to work, a more favorable cosmetic result and outcomes identical to the open procedure

 

Preoperative Workup

During your initial consultation, we will review your medical history as well as any outside reports, records, and outside X-ray films (e.g. CT scan, MRI, sonogram, renal scans, etc.).

A brief physical examination will also be performed at the time of your visit. If your surgeon determines that you are a candidate for surgery, you will then meet with a Patient Service Surgery Coordinator to arrange for the date of your operation.

NOTE: It is very important that you gather and bring all of your X-ray films and reports to your initial consultation with your surgeon.

Patients need to have the following preoperative testing done prior to surgery.

• Physical exam
• ECG (electrocardiogram)
• CBC (complete blood count)
• PT / PTT (blood coagulation profile)
• Renal Function Tests (blood chemistry profile)
• Urinalysis

Medications to Avoid Prior to Surgery

Aspirin, Ibuprofen, Vitamin E, and some other arthritis medications can cause bleeding and should be avoided 1 week prior to the date of surgery

Please contact your surgeon’s office if you are unsure about which medications to stop prior to surgery. Do not stop any medication without contacting the prescribing doctor to get their approval.

Bowel Preparation and Clear Liquid Diet

Do not eat or drink anything after midnight the night before the surgery.

 

The Surgery

The Operation

Laparoscopic pyeloplasty is performed under general anesthesia. The typical length of the operation is 3-4 hours. The surgery is performed through 3 to 4 small (0.5 -1cm) incisions made in the abdomen. A telescope and small instruments are inserted into the abdomen through these keyhole incisions, which allow the surgeon to repair the blockage/narrowing without having to place his hands into the abdomen.

A small plastic tube (called a double J stent) is left inside the ureter at the end of the procedure to bridge the repair and help in healing of the anastomosis and drainage of the kidney. This stent will remain in place for 4 weeks and is usually removed as a day care procedure. A small drain will also be left exiting your abdomen to drain away any fluid around the kidney and pyeloplasty repair.

Potential Risks and Complications

Although this procedure has proven to be safe, as in any surgical procedure there are risks and potential complications. Potential risks include:

Bleeding: Blood loss during this procedure is typically minor (less than 100 cc) and a blood transfusion is rarely required.

Infection: All patients are treated with broad-spectrum intravenous antibiotics prior to starting the surgery to decrease the chance of infection from occurring after surgery. If you develop any signs or symptoms of infection after the surgery (fever, drainage from your incision, pain or anything that you may be concerned about) please contact us at once.

Hernia: Hernias at incision sites may occur rarely as a delayed complication.

Tissue / organ injury: Although uncommon, possible injury to surrounding tissue and organs including bowel, vascular structures, spleen, liver, pancreas and gallbladder could require further surgery.

Injury could occur to nerves or muscles related to positioning. However these are self limiting.

Conversion to open surgery: this surgical procedure may require conversion to the standard open operation if extreme difficulty is encountered during the laparoscopic procedure. This could result in a larger standard open incision and possibly a longer recuperation period.

Failure to correct UPJ obstruction: Roughly 3 % of patients undergoing this operation will have persistent blockage due to recurrent scarring. If this occurs additional surgery may be necessary.

 

Post Operative Management

During your hospitalization

Immediately after the surgery you will be taken to the recovery room and transferred to your hospital room once you are fully awake and your vital signs are stable.

Hospital Stay: The length of hospital stay for most patients is approximately 2-3 days.

Diet: You can expect to have an intravenous catheter (IV) in for 1-2 days. (An IV is a small tube placed into your vein so that you can receive necessary fluids and stay well hydrated until you are able to tolerate a diet; in addition it provides a way to receive medication). Most patients are able to tolerate liquids by the evening of surgery and soft diet by the next evening. Once on a regular diet, drugs are usually changed to oral.

Postoperative Pain: Pain medication can be controlled and delivered by the patient via an intravenous patient-controlled analgesia (PCA) pump or by injection. You may experience some minor transient shoulder pain (1-2 days) related to the carbon dioxide gas used to inflate your abdomen during the laparoscopic surgery. This has no clinical significance and settles by itself.

Nausea: You may experience some nausea related to the anesthesia or pain medication. Medication is available to treat persistent nausea.

Urinary Catheter: You can expect to have a urinary catheter draining your bladder (which is placed in the operating room while the patient is asleep) for approximately 2-3 days after the surgery. It is not uncommon to have blood tinged urine for a few days after surgery.

Drain: You will have a drain coming out of a small incision in your side. This drain is placed in the operating room around the operative site to prevent blood and fluid from building up around the kidney and pyeloplasty repair. The drainage typically appears blood-tinged. It is usually removed within 2-3 days. Rarely persistent high volume drainage occurs and the patient may have to go home with the drain and have it removed on OPD basis.

Fatigue is common and should subside within a few weeks following surgery.

Incentive Spirometry: Breathing exercises using an incentive spirometry help prevent respiratory infections. Coughing and deep breathing is an important part of your recovery and helps prevent pneumonia and other pulmonary complications.

Ambulation: On the day after your surgery it is very important to get out of bed and begin walking. This helps prevent blood clots from forming in your legs.

Constipation/Gas Cramps: You may experience sluggish bowels for several days following surgery as a result of the anesthesia. Suppositories and stool softeners are usually given to help with this problem. Taking a teaspoon of liquid paraffin daily at home will also help to prevent constipation.

 

Discharge Instructions

Pain control: You can expect to have some pain that may require pain medication for up to a week after discharge.

Bathing: You may bathe after returning home. Your wound sites must be dried after bathing. Sutures in the skin will dissolve in 3-4 weeks.

Activity: Taking walks are advised. Prolonged sitting or lying in bed should be avoided. Climbing stairs is possible, but should be taken slowly. Driving should be avoided for at least 2-3 weeks after surgery. Absolutely no heavy lifting for 12 weeks after surgery. Most patients return to full activity on an average of 3 weeks after surgery. You can expect to return to work in approximately 2-4 weeks.

Stent follow up: The stent will remain in place for approximately 3-4 weeks and will then be removed as a day care procedure. It is not uncommon to feel a slight amount of flank fullness and urgency to void, which is caused by the stent. These symptoms often improve over time. If stent dysuria continues to be bothersome medication can be added to reduce the intensity of symptoms.

 

Follow-up

First follow up visit is done at 3-5 days after discharge to inspect the wound site. Dressings if required are changed or removed at this time. Histopathology report is usually available 5-7 days after surgery. You are supposed to sit and discussed the report with us in your follow up visit. Please preserve your histopathology report with yourself for future reference as this constitutes an important information for future reference.

CAUTION

Remember you have a stent inside your body which needs to come out at 3-4 weeks after surgery as shall be instructed to you. Failure to get it removed can result in severe complications like kidney damage, stone formations, infections and multiple surgeries for encrusted stent removal. So as much as the system takes care to remove your stent in follow up you also carry a responsibility to remember and get it removed after discussing with your doctor.

Contact your doctor if

• Any of your wounds become red, hot, swollen, painful or continue to discharge
• If your urine becomes cloudy, offensive smelling or you have any other signs of a urine infection
• If you have any concerns at all
• If you have fever >100°F or rigors and chills.