Pyeloplasty

This is an operation to repair / reconstruct a narrowing between the pelvis of the kidney and ureter. Please read PUJ OBSTRUCTION – pt guide for further details about the condition.

I have been told that I need a pyeloplasty. What happens next?

It is likely that you would have already had some blood tests and scans. In addition, the anaesthetist will need to see your ECG and chest x-ray; and, in some, an echocardiogram (ultrasound scan of your heart) as well.

It is likely that your urologist has gone through the procedure in detail including the short, medium and long-term complications. You may have already signed the informed consent form for the operation. If this is not the case, it is likely to be obtained after admission to hospital.

What happens actually after I get admitted to hospital?

You will be admitted the evening before surgery. You are best advised to have only a light dinner on the evening before surgery. Your anaesthetist may have prescribed a light sedative to be taken at night so that you sleep without too much anxiety. You will be asked to fast overnight (if the surgery is scheduled for the morning) for at least 6 hours.

In some patients an enema may be prescribed either on the night before or the morning of surgery.

You will be fitted for some special stockings (Thrombo-Embolic Deterrent – TED). These prevent you from developing clots (Deep Vein Thrombosis – DVT) in your legs. You will need to wear these before being taken to the operating rooms. You will also receive injections of heparin following the operation to protect against DVT.

My doctor has recommended a laparoscopic pyeloplasty. What is this?

In laparoscopic surgery, instead of making big cuts in the abdomen, small incisions are made, through which special tube like structures are inserted into the abdomen – these are called ‘ports’. A telescope (laparoscope) is introduced through one of the ports, serving as the surgeon’s ‘eye’. Special instruments are then inserted through 2 or 3 other ports to enable the surgeon dissect, cut or manipulate tissues. A camera is connected to the laparoscope so that the images are displayed on a TV monitor. The surgeon looks at this monitor and performs the surgery.

The narrow part (PUJO) is cut and reconstructed over a splint (stent). The stent is removed under local anaesthetic as an outpatient procedure at 4-6 weeks after the operation.

A drain tube is left close to the reconstructed ‘join’ (anastomosis). This is usually removed in 2-3 days. It is possible that sometimes you may be discharged home with this tube, only to be removed later in outpatient clinic.

You will have a urinary catheter in place for 24-48 hours after the operation.

What are the potential problems following the operation?

Stent related symptoms – urinary frequency, urgency and infection.
The stent may need repositioning – rare.
Continued obstruction (late) requiring further repair – rare.

Could you give me some DOs and DON’Ts after the operation