Why is it performed?
This is an operation performed to improve the function of the kidney, when it is not allowing urine to drain freely. This is usually because of a narrowing in the area where the kidney and ureter (the tube that connects the kidney to the bladder) are joined. This is called a pelvi-ureteric junction obstruction.
How is it Performed?
An incision (or cut) will be made across your side (flank area), through which your operation will be performed. The operation is performed under a general or spinal anaesthetic and takes about 2 hours. The length of stay in Hospital is usually about 7-10 days although, depending on you and your speed of recovery, it can be a little longer. The kidney and ureter junction are remodelled during the operation. During this time a small tube (called a stent) is placed inside the kidney and down the ureter into the bladder to ensure that urine can pass into the bladder whilst swelling and healing settles down after the operation. This is usually left in place for between 2-4 weeks and is then removed in the Day Unit, using a telescope into your bladder.
What are the Risks/Complications?
The risk of infection remains low. Excessive bleeding related to the procedure is very uncommon. The site of the operation where the ureter is rejoined to the kidney can occasionally develop a leak and for this reason a stent is inserted at the time of the operation; occasionally a further drain is inserted into the bed of the operation site to drain any excess urine. Generally problems are unusual but occasionally scar tissue may form which may hinder the flow of urine from the kidneys to the bladder. The success rate, therefore, related to the procedure is of the order of 90% and up to 10% of patients may require a second operation to give a longterm, permanent result.
What will happen before the operation?
You will usually be admitted to the ward a day or two BEFORE your procedure to allow us to prepare you and if necessary take further blood samples and get the anaesthetist to see you. You will be told when to stop eating and drinking and asked to shower (please do not use talcum powder) and put on a hospital gown. You will also be provided with elastic stockings which help prevent thrombosis (blood clots in the veins which arise as a result of reduced mobility). The doctors and nurses will ensure that you are informed and prepared for your procedure and are available to answer any other questions that you may have..
What will happen after the operation?
On return to the ward you may have a drip (intravenous infusion) in your arm to ensure that you have adequate fluid until you are able to eat and drink again (which will usually be a day or two later - the doctors and nurses will inform you when it is safe to do so). You will gradually be allowed to have small amounts of fluids, slowly increasing until food is tolerated. You will of course have a cut (or wound) which will be covered with a dressing; this will be sore (especially when you move or cough) but we will ensure that you have adequate pain-killers either by injection or, most commonly, from a little pump which goes into your drip, which you control with a button. You press it when you feel discomfort and receive a set dose of medication. You will also have another tube in the place where you usually pass urine (the urethra). It goes into the bladder and is held in place by an internal balloon. This will need to stay in place for several days so we can assess how your kidneys are functioning. This is then (painlessly) removed by the nurses.
What about when I go Home?
You will need a minimum of 6 weeks off from work to recuperate and some people take longer. Once home you will feel very tired as you begin to do more. This is normal; listen to your body and rest when tired. You must not do heavy lifting, housework or gardening for 6 weeks. Driving is also not allowed until your wound has fully healed and you are able to perform an emergency stop without discomfort - approximately 4 weeks; also avoid long journeys as a passenger in the early weeks as the seat belt may cause discomfort. You may have stitches to be removed, although they are frequently dissolvable. If you do need stitches removed after discharge you will be asked to visit the nurse at your GP’s. You may eat and drink normally at home. It is also essential that you drink plenty of fluids on a daily basis.
You will be asked to return to clinic for regular check-ups so that we can monitor the continuing function of the remodelled kidney. This may include repeat X-rays and ultrasound scans. You will be given this information on discharge from Hospital.