What does the procedure involve?
This describes a number of procedures to re-establish drainage of urine into the bladder when it has been interrupted because of scarring or damage to one of the ureters (the tubes which drain urine from the kidney to the bladder)
What are the alternatives to this procedure?
Long-term drainage with a ureteric stent, nephrostomy tube (external drain), conservative management (leaving the kidney to lose its function spontaneously).
What should I expect before the procedure?
You will usually be admitted on the morning of your surgery. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, and your named nurse.
You will be asked not to eat or drink for 6 hours before surgery. You will also be given an injection under the skin of a drug (tinzaparin) which, along with elasticated stockings provided on the ward, will help prevent thrombosis (clots) in your leg veins.
What happens during the procedure?
A full general anaesthetic (where you are asleep throughout the procedure) will normally be used. Drainage may be re-established by a variety of means; by directly re-joining the ends of the ureter above and below the area of blockage, by re-implanting the ureter into the bladder, by fashioning a tube of bladder to reach up to the ureter above the blockage (a bladder flap), by transferring the end of the blocked ureter over to the ureter on the other side or by replacing the ureter along its whole length with a segment of intestine (bowel).
The choice of procedure will be discussed with you in detail by your Consultant. However, it is often not clear before the operation which procedure will be most appropriate for your particular problem, so a range of options are usually discussed.
What happens immediately after the procedure?
An internal drain (ureteric stent) is usually placed across the join where the blockage has been in order to allow free drainage of urine into the bladder and to avoid leakage outside the ureter. There will be a drainage tube close to the wound to drain fluid away from the internal area where the operation has been done.
There is usually a catheter in the urethra (water pipe) and, possibly, an additional catheter directly into the bladder through the skin of the lower abdomen (a suprapubic catheter).
After the operation, you may spend some time in the Intensive Care Unit or in the Special Recovery area of the operating theatre before returning to the ward. You will normally have a drip in your arm and, occasionally, a further drip into a vein in your neck.
You will be encouraged to mobilise as soon as possible after the operation because this encourages the bowel to begin working. We will start you on fluid and food as soon as possible. We normally use elastic stockings to minimise the risk of blood clot (deep vein thrombosis) in your legs.
A physiotherapist will come and show you some deep breathing and leg exercises, and you will sit out in a chair for a short time after your operation.
If you have a drain or a tube in your blocked kidney (a nephrostomy tube), this may be removed on the ward or at a later stage after your discharge. The average stay in hospital will last approximately 5-10 days.
Are there any side-effects?
Most procedures have a potential for side-effects. You should be reassured that, although all these complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.
You may develop recurrent urine infections requiring long-term antibiotics. The function of the kidney may decrease with time.
Rarely, you may develop anaesthetic or cardiovascular problems possible requiring intensive care admission (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death). There may be a failure to establish good drainage requiring repeat surgery.
What should I expect when I get home?
When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.
It will be at least 6 weeks before full healing occurs. You may return to work when you are comfortable enough and your GP is satisfied with your progress. It can take several months for the strength of the wound to return to normal and you should avoid heavy lifting for up to 6 months.
What else should I look out for?
If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, please contact your GP. Any other post-operative problems should also be reported to your GP, especially if they involve chest symptoms.
Are there any other important points?
An appointment will be made within 6 weeks for you to have your stent removed, generally under local anaesthetic. This will be discussed with you and arrangements made before you go home. A follow-up outpatient appointment will be arranged for you some 10-12 weeks after the operation. You will receive this appointment either whilst you are on the ward or shortly after you get home.
