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Pyeloplasty (Kidney Tube Reconstruction for UPJ Obstruction) Postoperative Instructions

Hospital stay

Patients typically stay in the hospital for 24 hours for monitoring, intravenous fluids and pain management.

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. You may take walks outside. You may go up and down stairs. Your energy will return over the course of four to six weeks. You should avoid strenuous activity for 6-8 weeks. This includes activities such as running, tennis, lifting weights, etc. You should avoid carrying anything over fifteen pounds for 6-8 weeks.

Foley catheter

During surgery, you will have a Foley catheter placed in your bladder. A Foley catheter is a tube that carries urine from your bladder to the outside of your body into a bag. This urinary catheter will stay in place until your body heals. The catheter is typically removed the morning after surgery. It may need to be replaced if the bladder is slow to start functioning after anesthesia.

Surgical drain

A surgical drain called a Jackson Pratt or JP drain will be placed after surgery to drain excess fluid and blood from the body and to be sure there is no leakage of urine. It is expected to leak blood and fluid around the drain. The drain dressing often needs to be changed. It may be removed once the drain output is low, generally less than 50 mL over 8 hour periods. It may be removed before you leave the hospital or in the office a few days after you leave the hospital. If you go home with the drain, secure it by attaching it to your clothes with a safety pin. Place over the counter gauze around the drain daily and as needed once wet. Keep a record of how much it drains every 8 hours. Bring the record to the office for the nurse to review to see if it is safe to remove the drain.

Foley catheter

A plastic tube called a Foley catheter is typically left in place overnight to drain the bladder. This is usually removed the day after surgery at 6:00 AM. Once you have urinated or by 10:00 AM, an ultrasound is used to check how much residual urine remains in the bladder. If you are unable to urinate or unable to urinate completely, the Foley catheter will be replaced. You will go home with this for a few days. Your nurse will show you how to use this. If you go home with a catheter, he will need a nurse visit, typically in 3-7 days, to remove the catheter in the morning. You will then come back to the office the same day at 1:30 PM for a bladder scan to make sure the bladder is emptying well.

Dressings

Remove all surgical dressings 24 hours after surgery. You will likely have staples in the incisions. These are typically removed at your nurse visit one week after surgery. You do not need to place anything over the incisions. If any of the incisions or drain site ooze fluid or blood, you may place over the counter gauze daily and as needed.

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.

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 healing. 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.

Stent removal

Stents are often removed 6 weeks after surgery. The stent is typically removed in the office with a procedure called cystoscopy. 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 over-the-counter ibuprofen or acetaminophen (Tylenol) tablet before coming to your stent removal appointment if you’d like. You may drive yourself to and from cystoscopy with stent removal in the office. The stent is temporary and must be removed or changed within three months.

After stent removal

You may see blood or debris in the urine for a day or two. He may have burning with urination for a day or two. You may have stent symptoms for a day or two. You may use the measures mentioned above to manage stent symptoms. You may resume normal diet and activity. Be sure to drink plenty of water.

Postoperative appointments

If you go home with a Jackson-Pratt drain. This may be removed at a nurse visit in the office several days after surgery once the output is low. Skin staples are often removed nurse visit one week after surgery. Patients often has an appointment 1-2 weeks after surgery with the surgeon to review the pathology report. Call the office to make appointments if you do not already have them.

When to call the office or come the the ER

Call the office for fever over 101 degrees Fahrenheit, bright red blood in the urine, difficulty breathing, chest pain, dizziness, nausea, vomiting, leg swelling or pain. If you have the symptoms outside business hours, contact the call center or come to the ER.

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