ÃÛÌÒAPP

What is a robotic pyeloplasty?

A robotic pyeloplasty is a minimally invasive surgical procedure to correct a blockage or narrowing (PUJ obstruction) at the junction between the kidney and the tube draining urine (ureter) down to the bladder. The surgeon uses the DaVinci robot to perform the operation.

Why is it necessary?

To correct a blockage or narrowing which can be causing a problem to your health. This could potentially cause:

• pain
• infection
• high Blood Pressure
• kidney stones
• deterioration of the kidney function

The aim of the operation is to correct the blockage and prevent the risk of further problems occurring.

To find out the cause of the problem you will have been seen in the clinic to record the details of your symptoms and to be examined. You may be required to have a CT scan (a body x-ray) to let your urologist see the blockage or narrowing.

Before your procedure

What preparation is needed?

The most important preparation is for you to understand what is being done, why it is being done and for you to feel confident to have the operation. You need to be ready for a 2-4 day stay in hospital, but this can vary depending on the individual.

You need to bear in mind that you will be up and about a day or two after the operation. A period of 4-6 weeks for convalescence is also required, at home, before you get back to your normal activities.

If you are a smoker it is helpful if you can stop a few days before you come into hospital.

A routine blood or urine test will be required with possibly a heart tracing and chest x-ray to make sure you are fit for the operation. These are normally done in the pre-admission clinic, prior to your operation.

You will come into hospital on the morning of the operation and be seen by the nursing and medical staff on the ward.

The anaesthetist will explain what will happen when you are put to sleep. Elasticated stockings will be provided to prevent clots forming in the veins of your legs. You will also be given a daily injection to slightly thin your blood.

You will change into a hospital gown and be pushed to the operating department on your bed or on a trolley. The anaesthetist will put you to sleep usually by an injection in your hand.

During your procedure

How is the operation done?

The first part of the operation is to give you an anaesthetic (put you to sleep) so that you will not be aware of anything whilst the operation is being performed.

The operation can take 3-4 hours, but can vary depending upon the individual.

Three small cuts (approximately 1cm) are made in your stomach to perform the operation. A small plastic tube (stent) is placed inside the pipe leading from the kidney (ureter) at the beginning of the operation to bridge the surgical repair and help urine to drain freely from the kidney involved.

The tube will be left inside for 4-6 weeks and you will return as a day case to have this removed. This is done under local anaesthesia through the passage where you pass urine.

A tube (catheter) is placed into your bladder to allow urine to drain whilst you recover from your operation. The urine may have blood in it but this is normal and will clear in a day or two. The tube (catheter) will be removed once you are walking around, in a day or two.

You may also have a wound drain in your stomach to drain away any blood. This will be removed when there is little or no fluid draining from it.

After your procedure

What will happen after the operation?

You will wake up in the recovery area in your bed and when the nurses are happy with your condition a nurse from the ward will come to take you back to the ward.

You will have a drip in an arm vein. This is to keep you hydrated until you are drinking properly. You will feel ‘groggy’ during the first night after your operation and may have some pain. There are painkillers, which can be given by mouth; these can be enough to stop your pain. If this is not enough to keep you comfortable, a painkiller machine (PCA) may be put up for overnight use. A nurse will show you how to press a button to release the painkiller.

You may experience minor shoulder or stomach pain for up to two days following surgery. This is due to the gas used to inflate your stomach during surgery. Patients often describe this as a ‘wind like’ pain. You may feel sickly following your operation but medication can be provided to control this.

Remember that people recover at different speeds so do not worry if you do not seem to be recovering at the same speed as others.

The day after your operation the tube (catheter) and wound drain may be removed depending on the individual. If you are comfortable and do not feel sickly you may be allowed to eat and drink.

What problems can occur?

You will experience some pain and discomfort, this will settle and painkillers are available to help reduce this. If you are relatively young and medically fit there is only a small risk that the operation and anaesthetic will affect your health in any way (less than 1 in 1000).

If you do have other health problems such as a bad chest or angina, then the risks are slightly higher, but precautions will be taken.

The urologist performing your operation will tell you that there is a very small risk of having to perform open surgery if he has difficulties.

Are there any alternatives to this surgery?

The only alternatives to this kind of surgery are conventional open options which are now rarely performed.

What can I do when I get home?

Take it easy and build up your strength gradually over 4-6 weeks. Start with short walks and gentle exercise until you are fully back to normal. Try to eat a healthy diet with plenty of fluids. Fresh fruit and vegetables are important to keep your bowels regular as this operation can make your bowels ‘lazy’ for a few days.

Avoid heavy lifting, strenuous exercise and heavy housework during this period. Once you feel that you are back to normal it is safe to do household tasks and to drive. If you work it depends on you and the type of job you do, but 4-6 weeks convalescence is recommended.

A review appointment for twelve weeks will be arranged to check on your recovery from the operation.

A 4-6 week appointment will be sent for you to have your stent removed in the Urology Investigation Suite.

If you have any problems following your discharge from hospital you can contact your GP for advice. You will be given a letter for your GP when you leave the ward. A district nurse will be asked to visit you at home to check that your stomach wounds are healing.

Further information and advice

It is very important that you are happy to go ahead with your operation. The best time to ask questions is during your clinic visit with your urologist. In the pre-admission clinic you can speak to a nurse or junior doctor who will be happy to help. The consultant or his deputy will see you when you come into hospital to answer any further questions.

Contact details

Please ring switchboard and ask to be transferred to Ward 1 at the Freeman Hospital:

Telephone: 0191 233 6161

Finally

Most peoples’ stay in hospital is straightforward and they get the result they want. We hope that this webpage gives you the information that you need. Do not hesitate to approach a nurse or doctor if you have any questions or worries.