Postoperative Instructions For Ureteral Reimplant And Stent

Diet

After anesthesia, begin with clear liquids. You may take what you like to eat or drink. Depending on how you feel the following day, you may resume your normal diet. The appetite may be diminished the first several days at home. Drink plenty of water and avoid heavy meals.

Activity

Be sure to walk at least six times per day. This helps prevents blood clots in the legs, which can travel to the lung and become life-threatening. Start walking as soon as possible after surgery, either the afternoon of surgery or the morning after surgery.

Once home, You may take walks outside. You may go up and down stairs.

You should avoid strenuous activity for 6 weeks. This includes activities such as golf, tennis, cutting the grass, stretching exercises, lifting weights and so forth. You should avoid carrying anything over fifteen pounds for this six week period. This will help prevent hernia or bulge at the incision site.

You may tire easily with minimal activity. This is normal after surgery. Your energy level will gradually return in 6 to 8 weeks.

Foley catheter

You will have a foley catheter, a plastic tube that drains the bladder, in place after surgery. You will have this for 7 to 10 days after surgery. The nurses in the hospital will show you and your family how to care for the catheter. You will be taught how to use a smaller bag during the day which can be worn under clothes. You will be taught how to switch to a larger bag for night time. The catheter should always be secured to the leg so there is no tension or pulling on the catheter. Take care the catheter does not get dislodged when turning in bed, getting into or out of a chair or car.

You may see blood or small debris in the catheter tubing and bag. This is normal. Call the office or come to the emergency room if the catheter does not drain for 4 hours or there are large (dime sized) clots.

Surgical drain

You will have a surgical drain in place after the surgery. This removes excess fluids from the body. If the output is small, it may be removed before you leave the hospital. If there is still quite of bit fluid draining, you will be instructed how to care for the drain at home. Keep a record of how much fluid comes out of the drain. Bring this record when you return to the office so the nurse can review it and determine when it is safe to remove the drain. This will likely be a few days after you are discharged from the hospital.

Ureteral stent

A stent is a long, thin plastic tube that runs from the kidney to the bladder. It allows the kidney to continue draining during normal postoperative swelling. It protects the kidney from swelling and infection. Without it, it is likely you would have kidney stone symptoms. While the stent is in place you may have blood in the urine, bladder pressure or pain and frequent urination. You may see blood, clots and debris in the urine as long as the stent is in place. The more active you are, the more blood you may see in the urine. You may feel a sensation of needing to get to the bathroom right away. You may have pain in the back or side. This may be worse with urination. All of these symptoms are normal while the stent is in place. Symptoms are different for each person; some people have all of these symptoms, some have none.

Managing stent symptoms

• Drink plenty of water. Goal fluid intake is three liters or 100 ounces of fluid daily.
• Avoid constipation. Anesthesia and prescription pain medicine can cause constipation. Constipation makes stent pain worse. You may use over the counter MiraLAX, milk of magnesia, docusate (Colace), senna (sennaGen, Senokot), Dulcolax (bisacodyl). You may use over-the-counter suppositories [such as Dulcolax (bisacodyl)] or enemas (such as Fleets).
• Soak in a warm tub or shower.
• Heating pack or ice pack over the back or bladder.
• BenGay/IcyHot/Salonpas: Over the counter cream, patch or spray. Use as directed. May apply to the skin over your back or bladder.
• Acetaminophen (Tylenol): Over the counder pills. Take as directed or every six hours while awake. Do not take more than 3000 mg of acetaminophen per day. Prescription pain medicine may contain acetaminophen as well. This counts towards the maximum dose of 3000 mg of acetaminophen per day. Avoid if you have liver problems.
• NSAIDs (ibuprofen, Motrin, Advil, Aleve): Over the counter pills. Take as directed. May be combined with acetaminophen (Tylenol). Avoid or use with caution if blood tests show low kidney function or if you have chronic kidney disease or stomach ulcers.
• Azo (Urinary Pain Relief, Pyridium, phenzaopyridine): Over-the-counter pills. Take as directed. This helps relieve bladder pain. This turns urine and body fluids orange.
• Oxytrol patch (oxybutynin): Over-the-counter patch. This helps ease frequent urination and bladder spasm. Take as directed. This can be used in women and men.
• Tamsulosin (Flomax): This medication be prescribed by your provider. This helps relax the urinary system. It can help pass stone fragments and ease stent pain. Take this once or twice each day. Stop, decrease or take before bed if it makes you dizzy.
  Narcotic pain medication: This medication may be prescribed by your provider. Take as directed if you have pain despite the above measures. Narcotics can cause addiction, stomach upset, dizziness, confusion and constipation. Opiod abuse is a national epidemic. Be sure to dispose of unused medication once your surgical care is complete to protect your family from exposure.

Medication

You can obtain good pain relief by taking two acetaminophen (Tylenol) every four hours while awake for the first several days. You will also get a prescription for pain pills. You can use these prescription pain pills in addition to acetaminophen every four hours. Do not exceed 3000 mg acetaminophen per day.

Avoid constipation

Take a stool softener by mouth twice a day to avoid constipation. Constipation can cause you to strain to have a bowel movement, which puts stress on the surgery site and can cause bleeding and poor healing. A stool softener or laxative may be prescribed or is available at any drug store without a prescription (Senna or Senokot or SennaGen, Dulcolax or Bisacodyl, Milk of Magnesia or magnesium hydroxide). Decrease or hold the stool softener if you have loose stool or diarrhea.

Bathing

You may take a shower as you normally do. You may allow the water to run over the incision then pat dry. Avoid submerging in water for two days. You may have staples in the incision. These will be removed postoperatively. You do not need to place anything over the incision but may place a gauze if there is oozing or spotting.

Bladder x-ray (Cystogram)

Your surgeon may order a bladder x-ray called a cystogram. This is to check the bladder has healed completely and that there is no leak from the bladder. The cystogram determines if it is safe to remove the catheter. The office will arrange an appointment for a cystogram in the radiology department. You will come to our office immediately after the cystogram. The radiologist will call our nurse to let them know the cystogram is normal. Our nurse will remove the catheter if the cystogram is normal. If the cystogram shows a leak, the catheter is left in place. Often the cystogram is repeated after giving the bladder another week to heal.

Stent removal

The stent will be removed in the office during a cystoscopy and stent removal procedure. This involves placing a small camera in the bladder, grasping and removing the stent. The procedure usually takes only a minute or two and is typically uncomfortable but not very painful. You may take an acetaminophen (Tylenol) tablet before coming to your postoperative appointment if you’d like. The stent is temporary and must be removed within three months.

Postoperative appointment

You will need a postoperative visit in approximately 7-10 days after your discharge. If surgical staples are placed in the incision, they are typically
removed at that time. Call the office to make an appointment if you do not already have one.

Call the office or come to the emergency room for fever over 101^oF, difficulty breathing, chest pain, palpitations, nausea or vomiting, leg swelling or pain.